Minimally Invasive versus Open Spine Surgery: What Does the Best Evidence Tell Us?

Abstract

Background:Spine surgery has been transformed significantly by the growth of minimally invasive surgery (MIS) procedures. Easily marketable to patients as less invasive with smaller incisions, MIS is often perceived as superior to traditional open spine surgery. The highest quality evidence comparing MIS with open spine surgery was examined.Methods:A systematic review of randomized controlled trials (RCTs) involving MIS versus open spine surgery was performed using the Entrez gateway of the PubMed database for articles published in English up to December 28, 2015. RCTs and systematic reviews of RCTs of MIS versus open spine surgery were evaluated for three particular entities: Cervical disc herniation, lumbar disc herniation, and posterior lumbar fusion.Results:A total of 17 RCTs were identified, along with six systematic reviews. For cervical disc herniation, MIS provided no difference in overall function, arm pain relief, or long-term neck pain. In lumbar disc herniation, MIS was inferior in providing leg/low back pain relief, rehospitalization rates, quality of life improvement, and exposed the surgeon to >10 times more radiation in return for shorter hospital stay and less surgical site infection. In posterior lumbar fusion, MIS transforaminal lumbar interbody fusion (TLIF) had significantly reduced 2-year societal cost, fewer medical complications, reduced time to return to work, and improved short-term Oswestry Disability Index scores at the cost of higher revision rates, higher readmission rates, and more than twice the amount of intraoperative fluoroscopy.Conclusion:The highest levels of evidence do not support MIS over open surgery for cervical or lumbar disc herniation. However, MIS TLIF demonstrates advantages along with higher revision/readmission rates. Regardless of patient indication, MIS exposes the surgeon to significantly more radiation; it is unclear how this impacts patients. These results should optimize informed decision-making regarding MIS versus open spine surgery, particularly in the current advertising climate greatly favoring MIS.

Retrospective study of minimally invasive surgery verses open laminectomy or laminectomy with diskectomy

“…We 5,6 However, they found no significant difference in pain improvement between the two groups. 1 We have the same result as per hospital stay, however our study demonstrated better pain relief in open surgery group.…”

Opinion Piece: Patient-Specific Implants May Be the Next Big Thing in Spinal Surgery

“…Early on, Harrington's eponymous rods were also patient-specific and used in select cases prior to the transition to larger patient groups, widespread use and acceptance [41]. On the other hand, spinal surgeons and pioneers must not allow a sound theoretical basis, successful application in other fields and encouraging early results to drive unsubstantiated, widespread application, as some argue has occurred with certain Minimally Invasive Spinal Surgeries (MISS) [42]. Further, the possibility of unforeseen implant-related complications must not be discounted, either due to issues in the planning and implementation of a PSI [6] or inherent to the implant design or material [11,18,43].…”

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