Is Minimally Invasive Spine Surgery Also Minimally Pro-Inflammatory? Muscular Markers, Inflammatory Parameters and Cytokines to Quantify the Operative Invasiveness Assessment in Spine Fusion

Abstract

Over the last decades, minimally invasive surgery (MIS) techniques entered in the surgical routine due to their major advantage in reducing the unnecessary exposure of tissue and, thus, the trauma. Even in the context of orthopedics and spine surgery these practices have been widely developed and applied. Besides the clinical outcome of the patients, few studies have quantitatively assessed the traumatic and inflammatory effects of a specific surgical technique. Indeed, currently, a universally accepted biological outcome measure, such as a panel of biochemical markers, to define the success of MIS approach is still lacking. We reviewed the literature to collect the published data regarding the quantitative analysis of trauma induced by either conventional or minimally invasive surgery with the aim of highlighting evidence useful to guide future studies. Previous publications show some evidence in support of the hypothesis that MIS approaches are less traumatic, and possibly less pro-inflammatory, than conventional ones. Creatin kinase (as a marker of muscular damage) and C-reactive protein (as a marker of systemic inflammation) seem to reproducibly follow different trends in minimally invasive surgery compared to conventional procedures. Moreover, cytokines, such as interleukin (IL)-6 and IL-10 are also promising markers in this context.

Peri-Surgical Inflammatory Profile Associated with Mini-Invasive or Standard Open Lumbar Interbody Fusion Approaches

“…Minimally invasive surgery (MIS) techniques rapidly gained attention in surgical practice thanks to the significant advantage in reducing tissue exposure and trauma. In the last few years, MIS indications have grown, now covering the whole set of surgeries [ 1 , 2 ]. In spine surgery, MIS approaches cover the whole range of procedures [ 3 , 4 ].…”

“…In spine surgery, MIS approaches cover the whole range of procedures [ 3 , 4 ]. The technological advances acquired have allowed the application of different MIS procedures to a wide range of conditions (e.g., fractures, deformities, tumors) [ 1 ], but the more common use of MIS is in interbody fusion for the treatment of back pain [ 5 ], and sagittal [ 6 ] and coronal malalignment correction [ 7 ]. Hence, along with the potential benefits for patients, the reliability of MIS procedures in spine surgery relies on the pros and cons.…”

“…Inclusion criteria for MIS are similar, and somehow wider, compared to conventional open surgeries [ 3 ]. Furthermore, several advantages have been claimed: limited muscle trauma, quicker post-operative recovery and rehabilitation, reduced hospital stay, and improved clinical outcomes [ 1 , 8 ]. Spinal interbody fusion is the elective treatment in case of disc degeneration, spinal instability, trauma, and deformity.…”

“…It has been proposed that MIS procedures may result in a lesser degree of muscle injury, pain, blood loss, lower complication rate (e.g., lower rate of infections), and fewer use of hospital resources compared to conventional surgeries [ 6 , 10 , 11 ]. The main disadvantages are: the high technical demands, challenging learning/specific skills, and high operative costs due to the use of intraoperative imaging/guidance and expensive equipment [ 1 ].…”

“…From a clinical point of view, a quantification of spine arthrodesis invasiveness is still lacking. According to a recent review, C-reactive protein (CRP) and creatine kinase (CK) resulted as the most reliable markers of invasiveness [ 1 ]. However, being highly non-specific markers, their real utility, in this context, remains limited [ 8 ].…”