Mid-Course Report on MIS Spine Surgery

How well has minimally invasive spine (MIS) surgery lived up to expectations over the past decade?

That’s what a team from the U.S. and Germany set out to determine. Their work, “Complications in Minimally Invasive Spine Surgery in the Last 10 Years: A Narrative Review,” appears in the September 30, 2024 edition of Neurospine.

“Minimally invasive spine surgery has always been a disruptive force in spine surgery,” explained Osama Kashlan, M.D., M.P.H., a neurosurgeon at New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine in New York City, to OTW.

“However, over the last 10 years with the continued improvement in minimally invasive spine surgery techniques and the more widespread introduction of spine endoscopy in North America, it is the right time for this work because of the explosion of articles during that same timeframe comparing the different minimally invasive spine surgery techniques to open surgery.”

“As with any new technology, it is always important to ensure that outcomes of minimally invasive spine surgery are either the same or better than open surgery. This manuscript utilizes the newest data and articles to confirm that minimally invasive spine surgery is a technology that is here to stay.”

137 Studies Reviewed

The team reviewed 137 new MIS spine surgery studies and found that key complications in cervical minimally invasive spine surgery were:

• hematomas,
• transient nerve root palsy, and
• dural tears.

In thoracic minimally invasive spine surgery, it was:

• cerebrospinal fluid leaks and

In lumbar minimally invasive spine surgery, common complications were;

• incidental dural injuries,
• postoperative neuropathic conditions, and
• disc herniation recurrences.

As you can see, complications varied by surgical approach.

“Minimally invasive spine surgery has a very low complication profile overall especially when combined with navigation,” said co-author Galal Elsayed, M.D., a neurosurgeon at New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine in New York City. “Future uses of augmented reality will push the safety of minimally invasive spine surgery further.”

“The low rates of disk recurrence in the lumbar disk operations in all three minimally invasive spine surgery techniques was surprisingly lower than expected based on older studies showing recurrence rates of between 1-10%,” said Dr. Kashlan to OTW. “This demonstrates that potentially our modern techniques are helping with lowering symptomatic disk recurrences.”

OTW asked Dr. Elsayed about any limitations in the study and he said, “The most problematic of the limitations is the fact that our study lumps together all approaches and conditions into the three categories: tubular, uniportal, or biportal.”

“For example, tubular approaches include both midline approaches and paracentral approaches to reach far lateral disks. This group also includes patients with stenosis from ligamentous and bony hypertrophy with patients who have disk herniations. Experienced spine surgeons know that all these situations are confounders in terms of risk and patient outcomes. We attempted to alleviate this bias by being specific with the approaches and conditions treated in the tables.”

“Minimally invasive spine surgery techniques are critical for every spine surgeon to learn,” Dr. Elsayed told OTW. “Not all operations are best served with minimally invasive spine surgery techniques, but it is important for surgeons to have all tools in their toolbox to give their patients the best and more up to date care. The manuscript demonstrates clearly what the risks are of minimally invasive spine surgery and where it compares to open surgery.”