minimally invasive vs open spine surgery

Minimally Invasive Spine Surgery vs. Open Spine Surgery

Neck and lower and upper back pain affect just about everyone at some point. When you’re experiencing painful spine symptoms because of back conditions like a herniated disc or spinal stenosis, it can limit your ability to walk, sit and stand, especially for extended periods. The pain you feel can keep you from being able to work or enjoy everyday recreational activities.

If you’re one of those patients whose degenerative spine symptoms haven’t responded to conservative treatment, such as physical therapy, and your pain is chronic, you may welcome an alternative to open back surgery — minimally invasive spine surgery. This type of less-invasive spine surgery offers you many advantages, including a shorter hospital stay, faster recovery and less pain. In some outpatient minimally invasive spine surgeries, you may be able to go home the same day following your procedure.

Today, knowledgeable and experienced surgeons combined with advanced technology makes spine surgery less invasive, more effective and highly beneficial to patients with back or neck pain. If your doctor is recommending spine surgery, you can learn more about non-invasive spine surgery to see if it’s a good fit for your condition.

what is minimally invasive spine surgery

What Is Minimally Invasive Spine Surgery and Why Is It Minimally Invasive?

Minimally invasive spine surgery (MISS), when compared to the open surgery can be a safe, quick procedure with short downtime.

Minimally invasive back surgery uses small incisions. Your surgeon uses a video camera and tiny surgical instruments. The camera allows the surgeon to see the area affected while the instruments enable the doctor to carry out spinal procedures, such as spinal decompression or spinal fusions.

Minimally Invasive Methods

With MISS, there are several methods your surgeon can use to reduce trauma during surgery, including:

    • Using a Tubular Retractor to Perform the Surgery
      Rather than directly cutting into your muscles, your surgeon will instead use a method embodying progressive dilation of your soft tissues. The surgeon uses tubes to isolate your muscles, so they don’t expose the surgical area widely while working through the incision. Your surgeon may use a microscope or endoscopic focused down the tube through a minimal access method to help them perform the surgery.Once your surgeon completes the procedure, they remove the tubular retractor, giving your dilated tissues time to come back together. Your incisions will likely be small depending on the type and extent of your surgery.


benefits of minimally invasive spine surgery

    • Placing Rods and Screws Through the Skin
      Depending on your condition, your surgeon may have to utilize instrumentation, like screws and rods, to immobilize your spine to expedite spinal bone fusion or stabilize your spine.Traditional screw placement approaches require the surgeon to remove tissue and muscle from your spine surface. On the other hand, with skin (percutaneous) placement performed in a minimally-invasive procedure, the surgeon inserts screws and rods through smaller incisions in your skin without having to dissect or cut your underlying muscle. They use X-ray images to place guidewires through your skin into your spinal vertebrae along chosen screw paths.Then, the surgeon places screws over the guidewires and follows the wire path. Since the screws extend outside your skin with temporary extenders, the surgeon can remove them after having guided rod passage assistance to attach and secure the screws.
    • Using a Thoracoscopic Access Route
      Also depending on your condition, your surgeon may have to access the front sections of your thoracic spine that your lungs and heart surround in your chest. Traditional open surgery methods usually involve the surgeon having to make large incisions to open your chest, which could mean removing one or more of your ribs. But, with thoracoscopic access, the surgeon makes multiple smaller incisions to insert their cameras and working ports to facilitate surgery.
  • Using Direct Lateral Access Routes
    Often, the surgeon approaches your spine from the side of your body, particularly with procedures involving your lumbar spine. This helps reduce your pain since there’s not as much muscle tissue blocking the way. Once the surgical team places you on your side, the surgeon docks a tubular retractor on the side of your spine, so they can get access to your bones and discs of your spine.

Overall Benefits of Minimally Invasive Spine Surgery

The Journal of Neurosciences in Rural Practice reports minimally invasive spine procedures are often viewed as superior to standard open spine surgeries.

Since there’s less trauma to your soft tissues and muscles in a minimally invasive spine operation as opposed to open surgeries, your possible benefits include:

  • Less scarring
  • Better cosmetic results due to smaller incisions to your skin
  • Better cosmetic results due to smaller incisions to your skin
  • Less surgery-related blood loss
  • Reduced postoperative pain and risk of infection
  • Reduced risk of muscle and tissue damage since there’s less or no muscle cutting required
  • Quicker recovery and less rehabilitation needed
  • Less need for pain medication following surgery
  • Less time you spend in the hospital — usually less than two days
  • The potential for an outpatient procedure, where you go home the same day in a few hours

minimally invasive spine surgery procedures

Minimally Invasive Spine Procedures

Some non-invasive spine surgery involves laser technology use. Surgeons can use lasers to eliminate or separate tissue. Newer instruments are continually refined in minimally invasive spine surgery.

These days, surgeons can perform various types of spine surgery procedures using minimally invasive methods, such as:

  • Spinal Fusion: In this common MISS procedure, your surgeon uses spinal fusion to address problems you have with your vertebrae of your spine. They fuse your vertebrae — small bones — causing your pain to allow them to heal and help the bones become a solid, single and stable bone.
  • Decompression: The surgeon uses decompression to relieve spinal nerve pressure by removing sections of a herniated disk or bone.
  • Interbody Cage Fusion: This is a new spinal implant your surgeon fills with bone graft and inserts into the discectomy-made empty space. You can compare the cage to a tiny birdcage. Your surgeon packs bone graft around this cage after implantation. Like fusion and instrumentation, the bone graft grows around and into this cage creating a stable construct.
  • Discectomy and Microdiscectomy: These are procedures where the surgeon removes a portion of or your entire intervertebral disc. The way the two differ is the surgeon uses microscopic magnification in a microdiscectomy. The surgeon removes either a ruptured disc or herniated disc in these two procedures. A percutaneous discectomy surgically treat small herniated discs, pinched nerves, sciatica, disc denerations and more using minimally invasive techniques.
  • Laminotomy and Laminectomy: Both of these surgical procedures involve your lamina, which is a bony, thin layer covering your spinal canal. Your lamina may block your surgeon’s vision of an intervertebral disc. Your surgeon performs laminotomy to remove part of your lamina. With laminectomy, they remove the entire lamina.
    If you’ve a herniated intervertebral disc, your surgeon might have to remove the disc pieces compressing your nerve roots. Once they remove all or a portion of your lamina, your surgeon can see the disc better. Both procedures offer your surgeon better access to any part of your spinal anatomy, including your spinal canal.

A fundamental principle of the methods of minimally invasive spine surgery is soft tissues enveloping the spine are dilated using serial dilated, rather than cut. This results in less damage to the muscles and soft tissues, reduced pain and quicker recovery.

What Is Open Spine Surgery and Why Is It Invasive?

Many patients wonder what’s involved in open spine surgery, especially compared to minimally invasive spine surgery. The standard open spine surgery approach is an old-school neurosurgeons practice. During open spine surgery, your surgeon creates a large incision in your back. They then begin dissecting your spinal muscles to pull them away from your bones.

They’ll visualize the surgical area and use instruments to begin cutting the material away compressing the nerves of your spine. Once they complete the surgery, they remove the surgical instruments and suture up your incision.

open surgery requirements

Open surgeries require:

  • Anesthesia
  • Large incisions
  • Long surgery time
  • Muscle stripping
  • Hospitalization
  • Lengthy recovery time

Common general risks of open spinal surgery include:

  • Deep vein thrombosis — blood clots in your legs
  • Higher risk of adverse reactions to the anesthesia
  • Pulmonary embolus, which is a blood clot in the artery of your lung
  • Potential spinal fluid leakage leading to headaches
  • Post-operative pneumonia
  • Nerve damage
  • Blood loss during surgery requiring a transfusion
  • Infection at the surgery site

Specific risks of open spine back surgery include a higher risk of spinal cord or nerve injury resulting in pain — and in some cases, paralysis. You’ll experience pain from the operation and the instrumentation the surgeon uses could break, dislodge or irritate your surrounding tissues.

Key Differences Between Minimally Invasive Spine Surgery vs. Open Spine Surgery

There are some key differences between minimally invasive spine surgery and open spinal surgery which include:

surgeons use image guidance


When preparing for surgery, it doesn’t matter which of the two types of surgery you’re getting, you can make basic preparations. If you smoke, quit. Regularly exercise so you improve your recovery rate and discontinue using any herbal remedies or non-essential medication that could react with other medications or anesthetics. Be sure to ask your surgeon any questions you have.

Preparation is much more than physical activities — you also have to account for the psychological preparation. No matter what type of surgery you’ve decided on, you’re going to feel a significant amount of stress. However, with open spine surgery, the future operation and recovery process following could have a substantial impact on your physical, social and psychological state.

The open spine surgery procedure and the resulting pain are huge stressors, both physically and psychologically. This stress starts from the moment you decide to have the surgery to the completion of your recovery.

Also, your physical response to open surgery-related stress may also have harmful effects on your body in various ways such as having:

  • An increased heart rate
  • An increased blood pressure
  • A release of stress hormones
  • An increased muscle tension
  • A reduced blood flow to specific body areas
  • A shallow or rapid breathing
  • A slowed tissue healing time
  • A reduced immune system function

The potential benefits of minimally invasive spine surgery, as opposed to open surgery, help to reduce mental stress and make psychological preparation easier since there is

  • Less blood loss from the surgery
  • A smaller incision
  • Less risk of infection
  • Reduced muscle damage risk since there’s little to no muscle cutting
  • Shorter hospital stay
  • Less pain after surgery leading to less pain medication reliance
  • Faster recovery after your operation and less rehabilitation required

open surgery incisions

No matter which type of surgery you’re having, you should receive a medical evaluation from a doctor — whether it’s a pediatrician, family doctor or internist — to ensure you’re in good health and medical condition before you proceed with your surgery.

If you have a preexisting medical condition, you’ll require further assessment by a specialist. This could be specialists like a nephrologist, cardiologist, pulmonologist and more. Before your surgery, you’ll need to optimize your overall health.

Devices and Technology Used

Breakthroughs in technology have made minimally invasive spine surgery methods possible. Some inroads made in fluoroscopic imaging and X-ray technology and devices enable doctors to navigate inside your body without having to make large incisions. Surgeons make extensive use of image guidance when they’re placing their instruments during MISS surgeries.

In fact, some surgeons use state-of-the-art, innovative technology like intraoperative 3-D imaging. They depend on lighting sources and special retractors to help dilate tissues and muscles out of their way instead of having to cut them to move them, like they do in open surgery. With MISS, the surgeon’s hands are outside your body when they’re manipulating their instruments inside.

Size of Incision

In open surgery, the surgeon makes a six-inch or longer incision and moves your muscles to see your spine. This retraction or pulling of your muscles is common, and may lead to straining of your soft muscle tissue — and this is a downside to standard open surgery.

In contrast, the size of the incision in minimally invasive spine surgery is small, sometimes less than one inch or inch and one half in length. To perform the needed surgery, the surgeon accesses the spine through the chest, abdomen, neck or back and performs the needed surgery through a tiny incision.

exercise to improve recovery rate

Time Spent in Surgery and the Hospital

The average time a patient stays in the hospital after their open spine surgery is up to five days. But, with MISS, the hospital stay can be as short as two days. In some outpatient surgery cases, you can home the same day.

With MISS, you have:

  • Outpatient procedure options
  • The ability to walk in a few hours after your surgery

All these contribute to a speedier surgery.


MISS may not be suitable for all people and all spinal conditions. Certain conditions, such as severe scoliosis or spinal tumors, require open surgery. Your neurosurgeon will explain this to you and suggest the best surgery for your spinal condition depending on your diagnosis. You typically can’t have any severe deformity, spinal defect or have already had spinal surgery to qualify for MISS.


MISS results in lower complication rates, including less:

  • Risk of Infection: With non-invasive spine surgery, there’s a lower complication and infection rate. Because the surgeon makes a smaller incision, it helps to reduce your risk of infection. Additionally, surgeons report less postoperative complications and fewer deep vein thrombosis issues in minimally invasive surgeries. This speeds up the time it takes for you to heal and get back to moving around after surgery.
  • Blood Loss: When there are smaller incisions, there’s less blood loss, which can potentially improve your outcome. There are fewer blood transfusions today due to minimally invasive spine surgeries. Because of this, surgeons can perform fusion as outpatient procedures.
  • Pain: Patients undergoing MISS procedures often report experiencing less pain than they do with open surgeries since the surgeon disrupts less natural anatomy. As a minimally-invasive spine surgery patient, you’ll be able to get out of the outpatient clinic or hospital faster and get back to work quicker than if you had traditional open surgery. MISS procedures turn what could be a “dramatic surgery event” into a “less impact event.”

minimally invasive surgery less complications

Other complications include nerve damage. Your surgeon will take special precautions to ensure your risk is low. For instance, they may give you antibiotics to keep infections from occurring.


MISS procedures often make hospital or outpatient stays shorter. Although each patient varies in how long they need to stay in the hospital, typically patients who undergo MISS procedures go home in two or three days.

Since minimally invasive methods don’t disrupt your soft tissues and muscles, doctors believe you experience less post-operative pain than you do with open surgeries. Of course, you should expect some discomfort, but pain control advancements make it much easier for your doctor to relieve and manage your pain.

To help speed your recovery and regain your strength, your doctor might suggest physical therapy. This depends on the surgery you had and your overall physical health. You can perform specific exercises to help you become stronger, so you can get back to work and your day-to-day activities.

While it could take several months after a fusion procedure before your bone becomes solid, the level of your comfort improves more quickly. Your fused spine needs to stay in the correct alignment during this healing time. Your therapist teaches you how to move properly, stand, sit, walk and reposition.

Ensure your surgeon explains the type of spine surgery you’re having, and the differences between open surgery and minimally invasive surgery.

minimally invasive surgery recovery

Making the Decision Between Minimally Invasive Spine Surgery vs. Open Spine Surgery

When making your decision between minimally invasive spine surgery or open spinal surgery, you’ll need to be aware of your risks and options. Even in a minimally invasive procedure, you’re still undergoing surgery. Therefore, your decision still needs to be made carefully by both weighing the benefits and risks and talking to your orthopedic spine surgeon.

Be sure you work with a reputable, qualified and trusted orthopedic surgeon who keeps only your best interests in mind before you decide on which surgery approach you want to take. Your surgeon needs to be compassionate and caring, listening to all your concerns relating to your surgery. They should be more than willing to answer all your questions. Most importantly, they should treat you like a person, rather than a condition.

Some best practices you should follow when you’re looking for a top-rated surgeon include:

  • Ask your friends and family about their experiences with spine surgery, if they’ve had any
  • Speak with your primary care physician to see if you can get a referral
  • Read reviews of potential surgeons you’re considering

Take some time to learn all you can about your surgery and the approach your surgeon is going to take. By having a trusted surgeon by your side, you can worry less about the surgery and focus your attention on making a quick recovery and getting back to normal life.

talk to your orthopedic surgeon

Call Orthopedic Laser and Spine Surgery

If you’ve already tried numerous non-operative treatments and haven’t seen any significant improvement, or your symptoms worsen over a six to 12-month period, it might be time to consider having surgery. Here at Orthopedic Laser and Spine Surgery, we specialize in minimally invasive treatments that can provide you with all the benefits over open surgery described above.

Take the next step to start the process to see if you’re an eligible candidate for minimally invasive spine surgery by completing our candidacy check form. Consult with our orthopedic laser spine surgery doctors today to have your pressing questions answered and get the information you need. At Orthopedic Laser and Spine Surgery, we want to help you learn all you can about minimally invasive spine surgery and its benefits over open spine surgery. Contact us today for more information.

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