Minimally invasive spinal surgery procedures research
Researchers at New York University Langone Medical Center warn about the growth and popularity of minimally invasive surgery (MIS) procedures. They say that the procedures are easily marketable to patients as less invasive with smaller incisions, minimally invasive surgery is often perceived as superior to traditional open spine surgery. The NYU researchers put this to the test.
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A systematic review of randomized controlled trials involving minimally invasive surgery versus open spine surgery was performed.
- For cervical disc herniation, minimally invasive surgery provided no difference in overall function, arm pain relief, or long-term neck pain.
- In lumbar disc herniation, minimally invasive surgery was inferior in providing leg/low back pain relief, rehospitalization rates, quality of life improvement, and exposed the surgeon to >10 times more radiation (as the procedure requires imaging) in return for shorter hospital stay and less surgical site infection.
- In posterior lumbar fusion, minimally invasive surgery transforaminal lumbar interbody fusion (TLIF) had significantly reduced 2-year societal cost, fewer medical complications, reduced time to return to work, and improved short-term Oswestry Disability Index scores at the cost of higher revision rates, higher readmission rates, and more than twice the amount of intraoperative fluoroscopy.
- The highest levels of evidence do not support minimally invasive surgery over open surgery for cervical or lumbar disc herniation. However, minimally invasive surgery transforaminal lumbar interbody fusion demonstrates advantages along with higher revision/readmission rates.
- Regardless of patient indication, MIS exposes the surgeon to significantly more radiation; it is unclear how this impacts patients. These results should optimize informed decision-making regarding minimally invasive surgery versus open spine surgery, particularly in the current advertising climate greatly favoring minimally invasive surgery.1
In regard to minimally invasive cervical spine surgery, doctors writing in the Journal of neurosurgical sciences also examined minimally invasive surgery versus traditional surgery. They write that degenerative disorders of the cervical spine requiring surgical intervention have become increasingly more common over the past decade.
Traditionally, open surgical approaches have been the mainstay of surgical treatment. More commonly, minimally invasive techniques are being developed with the intent to decrease surgical morbidity and iatrogenic spinal instability. Iatrogenic is a term used to describe a worsening condition caused by surgery.
A multitude of studies demonstrating the significant incidence and impact of axial neck pain following open posterior spine surgery have led to a wave of research and development of techniques aimed at minimizing posterior cervical paraspinal disruption while achieving appropriate neurological decompression and/or spinal fixation.
- The currently available literature supports the use of minimally invasive posterior cervical laminoforaminotomy for the treatment of single-level radiculopathy.
- The literature suggests that fluoroscopically-assisted percutaneous cervical lateral mass screw fixation appears to be a technically feasible, safe and minimally invasive technique.
- Based on the currently available literature it appears that the DTRAX® expandable cage system is an effective minimally invasive posterior cervical technique for the treatment of single-level cervical radiculopathy.
- While several MIS approaches already exist, there is a need for advanced and improved techniques for use in posterior cervical surgery.2
In Germany however, doctors, while discussing the positives of minimally invasive spine surgery also discussed the common thread to all surgeries. The surgical risk.
Minimally invasive spine procedures, such as minimally invasive transforaminal interbody fusion seems to be a valid alternative to open spinal surgery. Both methods yield good clinical results with similar improvements of Oswestry Disability Index (ODI) and pain scores on follow-up.
There seems to be no significant differences in clinical outcome and fusion rates on comparison.
The most pronounced benefits of minimally invasive transforaminal interbody fusion are a significant reduction of blood loss, shorter lengths of hospital stay and lower surgical site infection rates.
On the downside, minimally invasive transforaminal interbody fusion seems to be associated with significantly higher intraoperative radiation doses, a shallow learning curve, at least in the beginning, longer operating times and potentially more frequent implant failures/cage displacements and revision surgeries.3
In research from August 2017 appearing in the British journal of neurosurgery:
“Though different techniques have been successfully employed in the treatment of recurrent lumbar disc herniation, the one which should be considered most ideal has remained a controversy, (minimally invasive surgical techniques).”
“In view of the currently available data and evidence, minimally invasive techniques for revision of recurrent disc herniation do not really appear to be superior to the conventional open surgical approaches and vice-versa. Spinal fusion should not be undertaken in all recurrences but should only be considered as an option for revision when spinal instability, spinal deformity or associated radiculopathy is present.”4
Continue on with these articles:
- Spinal fusion surgery complications and treatment options
- Spondylolisthesis | Spondylolysis | Spondylisis Fusion Alternatives
If you have questions about back or neck pain, get help and information from our Caring Medical staff
1 McClelland S, Goldstein JA. Minimally Invasive versus Open Spine Surgery: What Does the Best Evidence Tell Us? Journal of Neurosciences in Rural Practice. 2017;8(2):194-198.[Pubmed]
2 Skovrlj B, Qureshi SA. Minimally invasive cervical spine surgery. J Neurosurg Sci. 2017 Jun;61(3):325-334 [Pubmed]
3 Vazan M, Gempt J, Meyer B, Buchmann N, Ryang YM. Minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a technical description and review of the literature. Acta Neurochir (Wien). 2017 Jun;159(6):1137-1146. [Pubmed]