Beyond the Scalpel: Rethinking "Minimal" and "Optimal" in Spine Surgery

The terms "minimal" and "optimal" are widely used in surgical practice, yet their deeper meanings are rarely examined. This article uses minimally invasive spine surgery (MISS) as a case study to explore how these concepts shape clinical decision-making, guide innovation, and frame patient communication. While "minimally invasive" procedures are associated with reduced tissue trauma and faster recovery, these advantages are often evaluated through narrow technical metrics that may not fully capture the overall impact of surgery. Similarly, "optimal" extends beyond technical success to include efficacy, safety, patient values, and long-term outcomes, making it inherently context-dependent. Drawing on clinical literature and the philosophy of medicine, the article argues that "minimal" and "optimal" are relational and multidimensional constructs whose meaning emerges through clinical interpretation rather than fixed definitions. It further suggests that descriptions of MISS as "revolutionary" reflect rhetorical emphasis rather than a strict Kuhnian paradigm shift, and are better understood within cumulative models of development. The article additionally highlights the limitations of metric-based evaluation and emphasizes integrating empirical evidence with ethical reflection and clinical judgment. These considerations suggest that surgical terminology shapes clinical interpretation and patient expectations, underscoring the need for clarity and contextual sensitivity. Mismatches between expectations and outcomes may also influence patient experience and contribute to decisional regret.