Choice of minimally invasive approaches: A review of unique risks and complications

The goal of minimally invasive spine surgery is to obtain outcomes equivalent or superior to that of open procedures through a less morbid approach that features minimal disruption to the patient’s native anatomy. Tubular retractor systems and microscopes have become staples in the armamentarium of the minimally invasive spine surgeon and, as with any technological innovation, come with their own set of advantages and disadvantages. Working through a smaller surgical footprint makes mastery of the local anatomy of paramount importance. Many of the anatomical structures that surgeons rely on for reference during open approaches are not visible during minimally invasive approaches and can lead to surgeon disorientation. It is crucial that surgeons develop the ability to convert two-dimensional microscopic images to a three-dimensional representation of the surgical field. Minimally invasive spine surgeons have to adjust to the changes in control and tactile feedback afforded by the longer instruments required to work through narrow tubular retractors. Complications that occur during the approach, injury to the dura or vascular structures, for example, can be more difficult to manage within the confines of a minimally invasive approach. Minimally invasive surgeries (MIS) are technically demanding procedures that have a substantial but surmountable learning curve. The onus is on the minimally invasive spinal surgeon to develop a clear understanding of the complications associated with the various minimally invasive approaches and develop the ability to mitigate the risk of complications and manage them if they do occur.