Fundamental Concepts of Minimally Invasive Spine Surgery (MISS) and Purpose to Pursue

Abstract

Minimally invasive techniques are currently applied in large variety of spinal surgical procedures. Surgical invasiveness has been minimized mainly for surgical accesses but in some procedures (e.g. decompression surgery) also for the 'target surgery'. Despite different techniques, there are general principles which have to be considered. Only with combination of preoperative planning, the (educational) elaboration of a surgical strategy, the thorough knowledge of the patient's individual anatomy, the respect for the anatomy, properties and function of tissues, the well-trained surgeon, and the use of modern surgical high-tech-equipment will lead to an improvement of peri-and postoperative morbidity and clinical result for our patients. Minimally invasive spine surgery is a 'moving target' so it must be accepted that evidence Level I data in a scientific sense are still missing for some of these procedures. However, empirical data all suggest that minimally invasive spine surgery can significantly improve early post-op outcomes and decrease perioperative morbidity. It is thus the task of every spine surgeon to apply his experience-based expertise in a responsible way for the safety of our patients. Minimally invasive spine surgery is nothing but a 'natural evolution' of surgical technique to further decrease tissue trauma for certain operations.