What You Need to Know About Minimally Invasive Spine Surgery

By: GFM Advisory Team Member Dr. Robert Masson

Minimally invasive techniques have gained so much attention in the last several years and yet more often than not most patients really don’t understand the good, bad and ugly when making their own treatment decisions. Bottom line, the most important question regarding a proposed procedure and its benefit is ‘does the surgery hit the target?’ That is when minimally invasive technology becomes important. As an educated patient you need to understand the difference between the tools, the philosophy and the marketing.

Many tools are useful in minimally invasive spine surgery. Everyone knows about lasers, endoscopes, microscopes and so on. It is important to understand that every tool has a benefit when used properly and the benefits vary depending on the skill set of the surgeon using them. In other words, when you read about the miraculous benefits of laser surgery it is important to understand that a surgeon still needs to get the laser to the target, and it is the access that defines minimally invasive approaches. When the surgeon discusses the proposed ‘minimally invasive procedure’ it is not the tool used in dealing with a herniated disc but the amount of retraction, the amount of soft tissue damage, the accuracy of the approach and the efficiency of movement that defines the procedure as minimally invasive. It is critical not to be dazzled by the technology and to focus on the strategy being discussed when you choose a minimally invasive procedure.

Minimally invasive surgery is a philosophy not an approach. All well-rounded and competent spine surgeons have a variety of approaches and tools. They can approach the spine from the front, the back and the side, but it is choosing the best approach, and least trauma that defines a procedure as minimally invasive. The philosophy of minimally invasive spine surgery provides for all approaches to be done with minimal trauma and maximal benefit. Minimally invasive surgery goes wrong when it is minimal strategy surgery, or when the goals are sacrificed to achieve the outcome. It is critical that the goals of the surgery are understood, and that they have a statistically significant chance of achieving the outcome desired.

A thoughtful minimally invasive approach involves the highest sophistication in preoperative diagnosis and planning, and requires that significant effort is provided by the surgical team to understand the problem, the symptoms, the patient’s needs, expectations and goals and ultimately the liabilities as it relates to each individual patient.

How do we handle the marketing? There are many multibillion-dollar medical device companies marketing the tools and devices that they manufacture like the artificial disc, specific approach related retractor systems, endoscopes, and lasers. Surgical practices reflect these in their own marketing materials and websites. Don’t be afraid to ask how each surgeon uses these devices, how many have they done, are they limited to one approach, and to question how their use of ‘their tool’ will help you achieve your results. .

In order for a procedure to truly be minimally invasive, all components must be done diligently, with little trauma and with safety.

The bottom line is that a competent spine surgeon will do the procedure that they are good at, and that is thoughtful and well planned, whether it is minimally invasive or not.

It is important that as the patient you make your ultimate choices based on the relationship, your trust and the reputation of the surgeon. If it does not feel like a good fit, find a surgeon who is a good fit. You will live with the effects of the chosen surgery for the rest of your life.

Dr. Robert Masson, President of Neurospine Institute, is an internationally renowned neurosurgeon that has not only taught but developed many minimally invasive surgeries that he currently performs throughout the United States.