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Minimally Invasive Spine Surgery

12 Mar 2021

What is Minimally Invasive Spine Surgery?

Minimally invasive spine surgery (MISS) has been developed within the last 20 years in an effort to treat pathologies of the spine, causing only minimal tissue trauma. In general, each minimally invasive spinal procedure originates from a traditional – “open” procedure with well-established efficacy.

Minimally Invasive Alternatives

The aim of a MISS procedure is to achieve the same anatomical result as its open equivalent, with much less tissue trauma, and accordingly fewer tissue trauma-related complications. There are minimally invasive alternatives for most of the spinal surgery techniques: herniated disc removal, vertebral osteosynthesis for unstable fractures, spinal fusion, narrow canal decompression, even for complex surgery as scoliosis correction.

Technical Aspects of MISS

From a technical point of view, the aimed result of minimal trauma is achieved by the use of a tubular retractor in a way that pushes away muscle fibres instead of cutting them, for the surgical instruments to pass through. The use of a surgical microscope is imperative. Endoscopic spinal surgery is a variation of decompressive MISS, which uses an endoscope instead of the microscope and can be performed by even less traumatic “paths”.

Indications and Advantages of MISS

Besides the fact that there are minimally invasive equivalents for practically every spinal pathology that needs surgery, the indications may vary and often the use of traditional techniques is preferred, as being more relevant and expected to be more efficient for a specific patient’s pathology. The main advantage of MISS is less post-operative pain and more rapid recovery.

Disadvantages of MISS

Every MISS technique that has been established in clinical practice has been proven to offer at least an equivalent clinical result comparing to its open alternative. In many cases, minimally invasive techniques have been proven to be superior to their alternatives concerning post-operative pain, hospitalization duration, blood loss during surgery and infection rates. However, the main disadvantage of MISS is its relatively higher cost, related to the need for special equipment (microscope/endoscope and adapted instruments, which are often unique for each technique).


Despite the disadvantages, MISS is still considered cost-effective in most cases, as a result of the lower complication rate, shorter hospitalization, and faster recovery. Another disadvantage is the relatively long surgeon’s learning curve, which still prevents MISS from being available to patients in many cases. Each patient should trust a spinal specialist to decide mainly if a surgical treatment is an appropriate option for their problem. The choice of method follows, with MISS being relatively advantageous when performed by an experienced surgeon and when there is no specific reason to choose an open technique.

Written by Triantafyllos Bouras


Schematic illustration of various conditions of a lumbar canal (a single vertebra is presented in each one of the pictures, with the patient lying in prone position, his back being on the top of each picture):

A: normal canal
B: narrow lumbar canal
C: standard “open” laminectomy with bilateral muscle dissection, and
D: unilateral minimally invasive decompression with smaller skin incision, minimal muscle dissection and less bone resection

Copyright: R. Mobbs, published in August 2014, in “Mobbs R, Li J, Sivabalan P, Raley D, Rao P. Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy.
J Neurosurg Spine 2014 Aug;21(2):179-86

EUROSPINE is a society of spine specialists of various disciplines with a large knowledge of spine pathologies. All well-known and accepted treatment modalities for spine pathologies are represented by the members of the society. However, the Society cannot accept any responsibility for the use of the information provided; the user and their health care professionals must retain responsibility for their health care management.

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