1. Principles of Minimally Invasive Spine Surgery

MISS aims to achieve the same goals as traditional open surgery—relieving pain, restoring function, and stabilising the spine—but with smaller incisions, less tissue disruption, and reduced blood loss.

Key principles of MISS include:

• Preserving the integrity of muscles, ligaments, and other soft tissues
• Reducing blood loss and minimising postoperative pain
• Employing advanced imaging and surgical techniques for precision and safety

2. History of Minimally Invasive Spine Surgery

MISS has evolved over the past few decades. Early developments included percutaneous discectomy and nucleoplasty, which laid the foundation for more advanced techniques.

The introduction of endoscopic and microendoscopic approaches and improved imaging guidance facilitated the development of MISS procedures for various spinal conditions, such as herniated discs, spinal stenosis, and spinal instability.

3. Current Practice of Minimally Invasive Spine Surgery

Today, numerous MISS techniques address a wide range of spinal pathologies:

• Discectomy: Percutaneous, endoscopic, or microendoscopic discectomy involves the removal of a herniated disc fragment to relieve nerve compression and pain.
• Laminectomy and Foraminotomy: Minimally invasive laminectomy and foraminotomy are employed to treat spinal stenosis and foraminal stenosis by removing bone spurs and other structures causing nerve compression.
• Spinal Fusion: MISS fusion techniques, such as transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and lateral lumbar interbody fusion (LLIF), utilise smaller incisions and less tissue disruption to achieve spinal stabilisation.
• Disc Replacement: Artificial disc replacement using MISS techniques can preserve motion in the spine while alleviating pain from degenerative disc disease.

4. Cutting-Edge Developments in Minimally Invasive Spine Surgery

Endoscopic Spine Surgery

Endoscopic spine surgery is an advanced MISS technique that uses an endoscope—a small tube with a camera and light source—to visualise the surgical area.

This approach allows for even smaller incisions and further reduces tissue damage.

Endoscopic spine surgery has been successfully applied to discectomy, decompression, and fusion procedures, significantly improving patient outcomes.

Cervical Disc Replacement

Cervical disc replacement is a motion-preserving MISS procedure designed to treat cervical degenerative disc disease. The damaged disc is removed, and an artificial disc is implanted between the vertebrae, restoring disc height and preserving spinal motion.

This approach reduces the risk of adjacent segment degeneration, a common issue with traditional fusion procedures. Cervical disc replacement has been shown to provide excellent pain relief and functional improvement.

5. Benefits and Limitations of Minimally Invasive Spine Surgery

MISS offers numerous benefits over traditional open surgery, including:

• Smaller incisions and less tissue disruption
• Reduced blood loss
• Lower risk of infection
• Less postoperative pain
• Faster recovery and shorter hospital stays

However, MISS has limitations and may not be suitable for all patients or spinal conditions. Complex spinal deformities, severe instability, or previous spinal surgery may require traditional open surgery.

6. Future Direction of Minimally Invasive Spine Surgery

MISS continues to evolve, with ongoing innovations in surgical techniques, instrumentation, and imaging. Key future directions include:

• Advanced Imaging and Navigation Systems: Improved intraoperative imaging, such as 3D navigation and augmented reality, will further enhance the precision and safety of MISS procedures.
• Biomaterials and Biologics: The development of novel biomaterials and biologics, such as bone graft substitutes and growth factors, can improve fusion rates and minimize complications.
• Telemedicine and Remote Surgery: The integration of telemedicine and remote surgical systems can expand access to MISS, particularly in rural or underserved areas.

Minimally invasive spine surgery has come a long way since its inception, with endoscopic spine surgery, cervical disc replacement, and robotic-assisted surgery representing the cutting edge of spinal care.

These advancements have greatly improved patient outcomes, reduced complications, and expanded the range of treatable spinal conditions.

As MISS continues to evolve, we can expect even better results and further innovations, setting new standards in spine surgery and patient care.