Principles and Fundamentals of Minimally Invasive Spine Surgery

• Published in: World neurosurgery Vol. 119; pp. 465 - 471
• Main Authors: Del Castillo-Calcáneo, Juan, Navarro-Ramirez, Rodrigo, Gimenez-Gigon, Maximiliano, Adjei, Joshua, Damolla, Anwar, Nakhla, Jonathan, Hernandez, R. Nick, Hartl, Roger
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.11.2018
• Subjects: MISS; Muscle-sparing spine surgery; Navigation; Tubular spine surgery; MISS; Muscle-sparing spine surgery; Navigation; Tubular spine surgery; ELIF
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.06.205

Minimally invasive spine surgery (MISS) was defined by McAfee et al. in 2010 as a procedural approach that by virtue of surgical technique results in less collateral tissue damage, decreases morbidity, and provides patients with a more rapid recovery relative to traditional procedures. We reviewed all of our publications and presentations regarding MISS and summarize the main components and guiding principles to perform MISS as routine standard of care. The 4 T's of MISS is a concept that references the key elements that determine the success of MISS cases. The 4 T's are target (the patient and patient selection), technology (setting of the operation), technique (the surgeon), and teaching/training. MISS is an advancing field that has rapidly progressed in the past decade, and its role in treating complex spinal pathology will continue to expand. The 4 T's and the 3 technical principles of MISS are requirements for successful MISS. MISS is a dynamic field that is developing in parallel with technology, especially as it impacts imaging and surgical implementation. The ultimate goal of MISS is to achieve spinal health in the least invasive manner while avoiding overtreatment. MISS gives patients the best chance at favorable outcomes and shortest possible recovery course, while minimizing iatrogenic spinal instability. •MISS results in less collateral tissue damage, decreases morbidity, and provides the patients with a more rapid recovery.•The 4 T's and the 3 technical principles of MISS are requirements for successful MISS.•The ultimate goal of MISS is to achieve spinal health in the least invasive manner without overtreatment.•MISS gives the best chance at favorable outcome and shortest recovery course with minimal iatrogenic spinal instability.