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Complications in Minimally Invasive Spine Surgery in the Last 10 Years: A Narrative Review
Blake I Boadi1, Chibuikem Anthony Ikwuegbuenyi1, Sean Inzerillo2
1Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, NY, USA.
Objective:
Minimally invasive spine surgery (MISS) employs small incisions and advanced techniques to minimize tissue damage while achieving similar outcomes to open surgery. MISS offers benefits such as reduced blood loss, shorter hospital stays, and lower costs. This review analyzes complications associated with MISS over the last 10 years, highlighting common issues and the impact of technological advancements.
Methods:
A systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines was conducted using PubMed, MEDLINE, Embase via OVID, and Cochrane databases, covering publications from January 2013 to March 2024. Keywords related to MISS and complications were used. Studies on adult patients undergoing MISS with tubular, uniportal, or biportal endoscopy, reporting intraoperative or postoperative complications, were included. Non-English publications, abstracts, and small case series were excluded. Data on MISS approach, patient demographics, and complications were extracted and reviewed by 2 independent researchers.
Results:
The search identified 880 studies, with 137 included after screening and exclusions. Key complications in cervical MISS were hematomas, transient nerve root palsy, and dural tears. In thoracic MISS, complications included cerebrospinal fluid leaks and durotomy. In lumbar MISS, common complications were incidental dural injuries, postoperative neuropathic conditions, and disc herniation recurrences. Complications varied by surgical approach.
Conclusion:
MISS offers reduced anatomical disruption compared to open surgery, potentially decreasing nerve injury risk. However, complications such as nerve injuries, durotomies, and hardware misplacement still occur. Intraoperative neuromonitoring and advanced technologies like navigation can help mitigate these risks. Despite variability in complication rates, MISS remains a safe, effective alternative with ongoing advancements enhancing its outcomes.
Insights
Minimally invasive spine surgery (MISS) offers benefits but carries risks like nerve injury and dural tears. Technological advancements and neuromonitoring help mitigate these complications, enhancing safety and outcomes.
Area of Science:
- Spine Surgery
- Minimally Invasive Procedures
- Surgical Complications
Background:
- Minimally invasive spine surgery (MISS) utilizes small incisions and advanced techniques to minimize tissue damage.
- MISS offers advantages including reduced blood loss, shorter hospital stays, and lower costs compared to open surgery.
- Technological advancements are continually improving MISS outcomes.
Purpose of the Study:
- To systematically review complications associated with minimally invasive spine surgery (MISS) over the past decade.
- To identify common complications across different spinal regions (cervical, thoracic, lumbar).
- To analyze the impact of technological advancements on MISS complication rates.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searched PubMed, MEDLINE, Embase, and Cochrane databases (January 2013 - March 2024).
- Included adult patients undergoing MISS (tubular, uniportal, biportal endoscopy) with reported complications; excluded non-English studies and small case series.
Main Results:
- 137 studies were included from 880 initially identified.
- Cervical MISS complications: hematomas, transient nerve root palsy, dural tears.
- Thoracic MISS complications: cerebrospinal fluid leaks, durotomy.
- Lumbar MISS complications: incidental dural injuries, postoperative neuropathic conditions, disc herniation recurrence.
- Complication rates varied based on the specific surgical approach.
Conclusions:
- MISS reduces anatomical disruption, potentially lowering nerve injury risk compared to open surgery.
- Complications such as nerve injuries, durotomies, and hardware misplacement remain possible.
- Intraoperative neuromonitoring and navigation technologies can mitigate risks.
- MISS is a safe and effective surgical option with improving outcomes due to ongoing advancements.
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