Pathophysiology of Minimally Invasive Surgical Approaches: Current Concepts

Spine surgery is a continuously evolving field. Traditional posterior midline approaches to the lumbar spine are associated with muscle injury. Common mechanisms of injury include ischemia, denervation, and mechanical disruption of tendinous attachments of lumbar muscles. Muscle injury may be documented with chemical markers (creatinine kinase, aldolase, proinflammatory cytokines), by imaging studies, or with muscle biopsy. Minimally disruptive surgical approaches to the spine have the potential to minimize the trauma to muscular structures and thus improve the outcomes of surgery. The impact of minimally invasive spinal surgery on long-term clinical outcomes remains unknown. State-of-the-art pathophysiology of minimally invasive spine surgery is presented in this review.