Abstract
MISS as a concept is noble and all surgeons need to address and minimize the surgical
morbidity for better results. However, we need to be cautions and not fall prey into
accepting that minimally invasive spine surgery can be done only when certain metal
access systems are used. Minimally invasive spine surgery (MISS) has come a long way
since the description of endoscopic discectomy in 1997 and minimally invasive TLIF
(mTLIF) in 2003. Today there is credible evidence (though not level-I) that MISS has
comparable results to open spine surgery with the advantage of early postoperative
recovery and decreased blood loss and infection rates. However, apart from decreasing
the muscle trauma and decreasing the muscle dissection during multilevel open spinal
instrumentation, there has been little contribution to address the other morbidity
parameters like operative time , blood loss , access to decompression and atraumatic
neural tissue handling with the existing MISS technologies. Since all these parameters
contribute to a greater degree than posterior muscle trauma for the overall surgical
morbidity, we as surgeons need to introspect before we accept the concept of minimally
invasive spine surgery being reduced to surgeries performed with a few tubular retractors.
A spine surgeon needs to constantly improve his skills and techniques so that he can
minimize blood loss, minimize traumatic neural tissue handling and minimizing operative
time without compromising on the surgical goals. These measures actually contribute
far more, to decrease the morbidity than approach related muscle damage alone. Minimally
invasine spine surgery , though has come a long way, needs to provide technical solutions
to minimize all the morbidity parameters involved in spine surgery, before it can
replace most of the open spine surgeries, as in the case of laparoscopic surgery or
arthroscopic surgery.
Key words
Controversies in minimally invasive spine surgery - learning curve for MISS - complications
during learning curve - growth of MISS
