Paradigm changes in spine surgery-evolution of minimally invasive techniques

Zachary Adam Smith, Richard G. Fessler*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

87 Scopus citations


Minimally invasive spine surgery (MISS) techniques were developed to address morbidities associated with open spinal surgery approaches. MISS was initially applied for indications such as the microendoscopic decompression of stenosis (MEDS)-an operation that has become widely implemented in modern spine surgery practice. Minimally invasive surgery for MEDS is an excellent example of how an MISS technique has improved outcomes compared with the use of traditional open surgical procedures. In parallel with reports of surgeon experience, accumulating clinical evidence suggests that MISS is favoured over open surgery, and one could argue that the role of MISS techniques will continue to expand. As the field of minimally invasive surgery has developed, MISS has been implemented for the treatment of increasingly difficult and complex pathologies, including trauma, spinal malignancies and spinal deformity in adults. In this Review, we present the accumulating evidence in support of minimally invasive techniques for established MISS indications, such as lumbar stenosis, and discuss the need for additional level I and level II data to demonstrate the benefit of MISS over traditional open surgery. The expanding utility of MISS techniques to address an increasingly broad range of spinal pathologies is also highlighted.

Original languageEnglish (US)
Pages (from-to)443-450
Number of pages8
JournalNature Reviews Neurology
Issue number8
StatePublished - Aug 1 2012

ASJC Scopus subject areas

  • Clinical Neurology
  • Cellular and Molecular Neuroscience


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