Minimally invasive spinal surgery procedures research

Danielle.Steilen.ProlotherapistDanielle R. Steilen-Matias, PA-C

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.

A systematic review of randomized controlled trials involving minimally invasive surgery versus open spine surgery was performed.

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.

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

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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]

4 Onyia CU, Menon SK. The debate on most ideal technique for managing recurrent lumbar disc herniation: a short review. British Journal of Neurosurgery. 2017 Aug 22:1-8. [Pubmed] [Google Scholar]

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