The goal of minimally invasive or less invasive surgery at the level of the spine remains the same as for a formal, open surgical procedure. The incision and tissue dissection to the spine may be less, but the surgical procedure still needs to address the abnormality of the spinal column. By definition, minimally invasive surgery utilizes smaller skin incisions.

More importantly, minimally invasive and less invasive surgery minimize the damaging effects of large muscle dissection or retraction, and attempts to leave the body as naturally intact as it was prior to surgery. The goal is to achieve rapid recovery, lessen post-operative pain, and leave cosmetically satisfying incisional scars. Advantages can also include decreased pain, and faster return to activities. These theoretical advantages have been demonstrated but not proven in many, but not all minimally invasive and endoscopic procedures.

Even today only a small percentage of spinal conditions are suitable for endoscopic surgery, however there are ways to decrease the muscle dissection by performing mini-open procedures, hence the term less invasive surgery. These mini-open procedures allow fusion and instrumentation, procedures that classically involve much larger incisions and muscle dissection. It is appropriate to discuss with your spine surgeon if your particular condition is amenable to a minimally invasive approach, but the outcome of the surgery should not be compromised for a smaller incision.

Potential areas of minimally invasive procedures include:

• Decompression - posterior decompression through tubes
• Instrumentation - posterior instrumentation through tubes

• Anterior fusion thoracoscopically
• Anterior fusion and instrumentation thoracoscopically

• Anterior fusion - laparoscopically, extreme lateral interbody fusion (XLIF) or mini-open
• Anterior instrumentation -­ laparoscopically or mini-open
• Posterior decompression -­ through tubes or mini-open procedures
• Posterior fusion -­ through tubes or mini-open procedures
• Posterior instrumentation -­ through tubes or mini-open procedures
• Posterior lumbar interbody fusion (PLIF or TLIF) ­- through tubes or mini-open procedures

Muscle dilation and tubes are used to provide direct access to the spine and allow use of conventional, modified instruments through much smaller incisions and much less muscle dissection.

Endoscopy is the visual inspection of any cavity or space by means of an endoscope. Thorascopy is the visualization of the thoracic cavity or the chest. Laproscopy is the visualization of the abdominal cavity. Laproscopy is used to assist in procedures on the lumbar spine. Need diagrams

What is the purpose of utilizing the endoscope? The endoscope allows the surgeon to have an illuminated and magnified view of the operating field without having to make a large incision. With the assistance of the endoscope surgeons can utilize several small incisions to perform the same procedure they would otherwise perform using a single large incision.

Possible Risks/Complications
The possible risks and complications are the same in minimally invasive/less invasive surgery as compared to open surgery. The goal has been to decrease the complication rate, but this is only a theoretical and unproven benefit of the surgery. Studies are underway to better determine the risks and benefits of minimally invasive/less invasive surgery.

After Surgery
Generally, patients have required less pain medication. Blood loss and hospital stays have decreased, and rehabilitation exercises are started sooner. Studies are underway to better determine the long-term benefits and outcome of minimally invasive/less invasive surgery.