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What are the benefits of Minimally Invasive Spine Surgery?

A doctor explains with a human spine model.
Published by Dr. Umesh Srikantha on April 12, 2020

Minimally invasive spine surgery offers several benefits to the patient. Because of the basic concept of preserving muscle attachments and reducing damage to the posterior midline bone-ligament complex, it ensures better post-operative spinal stability and better post-operative extensor muscle strength as compared to people who have undergone conventional open surgeries.

The major benefits of MISS revolve around its basic concept of causing reduced trauma to the supporting structures of the spine (Posterior tension band, lamina and Paraspinal muscles). These afore mentioned structures are usually not involved in the pathologic process and more often they are innocent bystanders that are traumatized while gaining access to the site of actual pathology. Though, from a patients’ perspective, smaller and cosmetic incisions are the most attractive benefits, the actual advantages are much more, in terms of biomechanical (Table. 2) or clinical factors. (Table. 1)

Table 1. Clinical benefits of MISS (Direct benefits to the patient)

Clinical benefits of MISS

Reduced peri-operative blood loss

Less post-op pain

Less post-op analgesic requirement

Less hospital stay duration

Early return to work and normal activity

Less incidence of post-operative wound infections (Superficial and deep)

Improved clinical outcomes (ODI scores)

Smaller incisions (cosmetically better)

ODI – Oswestry Disability Index

Table 2. Biomechanical benefits of MISS (Indirect benefits to the patient)

Biomechanical benefits of MISS

Remarks

Preserved muscle attachments

Serial dilatation to create a trans-muscular or inter-muscular tract to the area of pathology preserves muscle attachments

Reduced retraction induced damage

Reduced intramuscular pressure in adjacent muscles

Intact post-operative segmental motion

Avoids segmental hyperflexibility – a common side effect of injury to posterior tension band in conventional surgeries

Improved post-operative extensor muscle function

Extensor muscle cross-sectional area and strength better preserved after MISS

Reduced post-operative inflammatory response

Elevations in CPK, CRP, peripheral IL-6 and NKCA significantly lower after MISS as compared to conventional open procedure.

Improved short-term and long-term radiological parameters

Reduced immediate post-op T2W signal changes within multifidus and better long-term muscle cross-sectional area after MISS

CPK – Creatine Phosphokinase; CRP – C-reactive protein; IL-6 – Interleukin-6; NKCA – Natural Killer cell activity; T2W – T2 weighted MRI sequence

References:

  • Tian N-F, Wu Y-S, Zhang X-L, Xu H-Z, Chi Y-L, Mao F-M. Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence. Eur Spine J. 2013;22(8):1741-1749. doi:10.1007/s00586-013-2747-z.
  • Starkweather AR, Witek-Janusek L, Nockels RP, Peterson J, Mathews HL. The multiple benefits of minimally invasive spinal surgery: results comparing transforaminal lumbar interbody fusion and posterior lumbar fusion. J Neurosci Nurs. 2008;40(1):32-39.
  • Fan S, Hu Z, Zhao F, Zhao X, Huang Y, Fang X. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J. 2009;19(2):316-324. doi:10.1007/s00586-009-1191-6.
  • MD APW, MD ZAS, MD JASI, et al. Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF). Neurosurgery Clinics of NA. 2014;25(2):279-304. doi:10.1016/j.nec.2013.12.007.
  • Parker SL, Lerner J, McGirt MJ. Effect of Minimally Invasive Technique on Return to Work and Narcotic Use Following Transforaminal Lumbar Inter-body Fusion. Professional Case Management. 2012;17(5):229-235. doi:10.1097/NCM.0b013e3182529c05.
  • Wu M-H, Dubey NK, Li Y-Y, et al. Comparison of minimally invasive spine surgery using intraoperative computed tomography integrated navigation, fluoroscopy, and conventional open surgery for lumbar spondylolisthesis: a prospective registry-based cohort study. Spine J. 2017;17(8):1082-1090. doi:10.1016/j.spinee.2017.04.002.
  • Schizas C, Tzinieris N, Tsiridis E, Kosmopoulos V. Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. International Orthopaedics (SICOT). 2009;33(6):1683-1688. doi:10.1007/s00264-008-0687-8.
  • Granger E, Prada S, Bereczki Z, Weiss M, Wade C, Davis R. Return-to-Duty Rates Following Minimally Invasive Spine Surgery Performed on Active Duty Military Patients in an Ambulatory Surgery Center. Mil Med. 2018;24(6):769. doi:10.1093/milmed/usx104.
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