Paradigm changes in spine surgery: evolution of minimally invasive techniques

Area of Science:

• Orthopedics
• Neurosurgery
• Minimally Invasive Surgery

Background:

• Minimally invasive spine surgery (MISS) was developed to reduce complications associated with traditional open spinal procedures.
• Early applications, such as microendoscopic decompression of stenosis (MEDS), demonstrated improved outcomes, leading to widespread adoption.
• Surgeon experience and clinical evidence increasingly favor MISS over open surgery.

Purpose of the Study:

• To review the accumulating evidence supporting minimally invasive techniques for established indications like lumbar stenosis.
• To discuss the need for further high-quality clinical data (Level I and II) to compare MISS with open surgery.
• To highlight the expanding application of MISS for complex spinal conditions.

Main Methods:

• Review of existing clinical evidence and surgeon experience reports on minimally invasive spine surgery (MISS).
• Analysis of the utility of MISS for various spinal pathologies, including stenosis, trauma, malignancies, and deformity.
• Identification of areas requiring further research, specifically Level I and II data for comparative effectiveness.

Main Results:

• Minimally invasive surgery for microendoscopic decompression of stenosis (MEDS) shows improved outcomes compared to open surgery.
• Growing evidence suggests a preference for MISS over open approaches in spine surgery.
• MISS is increasingly being applied to more complex spinal pathologies, including trauma, tumors, and adult deformity.

Conclusions:

• Minimally invasive spine surgery (MISS) techniques offer significant advantages for established indications and are expanding to complex cases.
• Continued research, particularly Level I and II studies, is necessary to definitively establish the superiority of MISS over open surgery for all indications.
• The role of MISS in modern spine surgery is expected to grow, addressing a wider spectrum of spinal conditions.