1 Minimally Invasive Spinal Instrumentation: Past, Present, and Future

Benjamin Khechen, Britany E. Haws, Kaitlyn L. Cardinal, Jordan A. Guntin, and Kern Singh

1 Minimally Invasive Spinal Instrumentation: Past, Present, and Future

In recent decades, technological advances in minimally invasive spine (MIS) surgery have revolutionized the surgical management of spinal pathology. The primary goal of MIS remains the improvement of postoperative outcomes and patient satisfaction. Compared to “traditional” open approaches, MIS techniques have demonstrated reduced intraoperative blood loss, shortened length of inpatient stay, decreased complications, and reduced postoperative pain and narcotics consumption. ¹ ^, ² ^, ³ ^, ⁴ MIS approaches in spine surgery have proven to be cost-effective through the reduction of morbidity and enhanced utility in ambulatory surgical centers. ⁵ ^, ⁶ ^, ⁷ ^, ⁸ Furthermore, MIS surgery has provided a surgical option for elderly patients deemed inappropriate surgical candidates for open procedures. ⁹ ^, ¹⁰ ^, ¹¹ ^, ¹²

The modern MIS surgery era was launched in 1997, with the first reported microendoscopic diskectomy published by Foley and Smith. ¹³ This was followed in 2001 by Foley’s novel technique to pass rods percutaneously using an arc-based approach. ¹⁴ In the ensuing years, the first reports of MIS fusion techniques were published, including MIS posterior lumbar interbody fusion in 2002 ¹⁵ and MIS transforaminal lumbar interbody fusion in 2006. ¹⁶ MIS approaches have since been developed for several conditions including degenerative, deformity, and oncologic pathology. ⁹ ^, ¹⁰ ^, ¹¹ ^, ¹² ^, ¹⁷ ^, ¹⁸

A promising future truly exists for MIS surgery. New technologies are now being developed with the specific intention of use in MIS surgery. Greater attention has been placed on surgical navigation systems that provide improved accuracy in screw placement. ¹⁹ ^, ²⁰ ^, ²¹ The role of intraoperative image guidance will continue to evolve in MIS surgery, particularly as technological advances make these systems more adaptable and cost-effective. However, spine surgeons must retain a level of sensibility when considering the use of these new technologies in MIS surgery. As with all surgical techniques, a learning curve exists for MIS surgery. As such, these techniques must be comprehensively taught in residency programs to better equip future spine surgeons.

This text is intended to provide a comprehensive overview of current MIS instrumentation for senior spine surgeons, spine surgeons in training, and surgical assistants. Section 1 details instrumentation utilized in MIS posterior approach, followed by Section 2, which details instrumentation used in lateral MIS approach. Section 3 provides information on current biologics and surgical navigation systems used in MIS surgery. We would like to extend our appreciation to the spinal device companies that have agreed to participate in our textbook.

References

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