Here in Tampa, we are in a media war over Spine Surgery Services. It has become a very competitive business, with many Centers or Institutes deploying expensive marketing teams touting expertise in Minimally Invasive Spine Surgery. It does sound great. But what does Minimally Invasive Spine Surgery mean?
About 30 years ago, spine surgery was associated with larger incisions, long recoveries, and unpredictable results. With better diagnostic tests (CT scans, MRI’s, etc) spinal surgery has become more predictable for certain problems. At this time, most spine surgeons will agree that the most straight forward problems, such as single level disk herniations, focused spinal stenosis, and single level spinal instability have predictable surgery success rates.
The use of magnification, and x-ray localization, and smaller incisions has become mainstream. I will submit the smaller incision is what most patients consider as being Minimally Invasive Spine Surgery. Because of that definition, most spine surgeons today are using some form of minimally invasive spine surgery.
On the other hand, Spine Surgeons have some more specific criterion to define Minimally Invasive Spine Surgery (MIS). Some surgeons define MIS as using blunt dissection and muscle sparing techniques to minimize post operative scaring. Some surgeons define MIS fusion as approaches that spare the multifidus muscles.
In the end, no matter what you call it, there is a hope that the MIS technique will have some identifiable advantages. Most scientific studies have shown that if the goals of surgery has been achieved, no matter the specific technique, the results are good. Some MIS studies have show some short term benefits such as faster recovery. Others, however, have shown increased complication rates, and increased rates of revision surgery. There is a hope that some of the minimally invasive techniques will help avoid late instabilities that develop after decompression, but so far the results have not been conclusive.
Because of the competitive nature of the Spine Surgery business, the term Minimally Invasive Spine Surgery has become more of a marketing term than a medical one. While many Surgeons are determined to prove the specific techniques beneficial, it is still too early to say the techniques are true long term advantages. From my experience, the minimally invasive approach has made outpatient spine surgery a reality, and that is a good thing.
Surgeons that are focused on achieving the primary surgical goals will likely achieve good outcomes. From the patient perspective, they should find that Surgeon that has that focus. Forget the marketing. Let the scientific community debate the nuanced benefits of certain techniques. Patients should look for the surgeon with predictable results, and experience to maximize surgical success. No matter what you call it, the outcome is the most important factor.
- Gum JL. The business side of medicine for orthopedic residents and fellows: when were we supposed to learn this? Am J Orthop (Belle Mead NJ). 2014 Aug;43(8):E189-90. PubMed PMID: 25136878