The Impact of "Keyhole" When Discussing Spine Surgery: A Deep Dive Into Patients' Perception of Minimally Invasive...

Minimally invasive spine surgery (MISS) has gained popularity owing to improved short-term outcomes and technological advances despite comparable risks and similar long-term results with open surgery. The gold standard hence remains an ongoing debate among spine surgeons, heavily influencing the surgical techniques offered. However, the patients' perspective of MISS has remained grossly underexplored, despite buzzwords like "keyhole" and limited patient education possibly influencing their decision-making for surgery. This study aims to evaluate patients' current perception of spine surgery with a focus on MISS and whether this perception changes with "keyhole" surgery mentioned.

A 5-section anonymous questionnaire was conducted from June to November 2024 a a tertiary hospital in Singapore. The questionnaire collected patients' biodata, perspective of spine surgery, and knowledge, perspective, and demand for "keyhole" spine surgery. We included symptomatic surgical candidates with degenerative lumbar pathologies indicated for decompression and/or fusion surgery. All patients with lumbar pathologies secondary to trauma, infection, inflammation, or tumors were excluded.

A total of 50 patients participated in the study. All 50 patients understood that "keyhole" meant MISS. Of these, 92% chose "keyhole" surgery over open surgery, citing lower complication risks (67%) and better outcomes (65%) as primary reasons. Most patients viewed "keyhole" surgery as a minor (44%) rather than a major surgery (18%), with 74% believing most to all patients are suitable candidates. As a result, more than 50% were willing to wait longer, pay more, and travel further for MISS. Despite this strong demand, most (90%) were unaware of the difference between endoscopic, tubular approaches, and MISS, and 100% were unaware of uniportal and biportal terminology.

The term "keyhole" transforms patients' perspectives of spine surgery. Many who initially perceived spine surgery as high-risk view MISS as a safer alternative, associating it with fewer complications and better outcomes than open surgery. While demand for MISS is high, misconceptions about its complexity and limitations remain.

Addressing patients' misconceptions requires effective patient education to ensure expectations align with clinical realities, fostering trust and satisfaction from the preoperative stage. Furthermore, the preference for MISS underscores the importance of surgeons being proficient in both open and minimally invasive approaches, enabling adaptation to individual patient needs.