List common applications of MIS techniques for cervical spine pathology


• Tubular laminoforaminotomy

• Posterior screw-rod fixation (lateral mass screws) and fusion Anterior-Based Approaches

• Endoscopic approaches to the upper cervical spine and craniovertebral junction

• Anterior cervical foraminotomy

Key Points

1. Minimally invasive spine procedures intend to limit approach-related surgical morbidity through use of smaller skin incisions and targeted muscle dissection but do not eliminate the potential for serious and life-threatening complications.

2. Use of minimally invasive spine techniques is widespread but claims that MIS procedures are more effective than traditional spine procedures await validation in the current medical literature.


Society for minimally invasive spine surgery:

Lumbar lateral transpsoas approach:


1. Arts MP, Brand R, van den Akker ME, et al. Tubular diskectomy vs. conventional microdiskectomy for sciatica: A randomized controlled trial. JAMA 2009;302:149-58.

2. Bergey DL, Villavicencio AT, Goldstein T, et al. Endoscopic lateral transpsoas approach to the lumbar spine. Spine 2004;29:1681-8.

3. Brau Sa. Mini-open approach to the spine for anterior lumbar interbody fusion: Description of the procedure, results and complications. Spine J 2002;2:216-23.

4. Cragg A, Carl A, Casteneda F, et al. New percutaneous access method for minimally invasive anterior lumbosacral surgery. J Spinal Disord Tech 2004;17:21-8.

5. Eck JC, Hodges S, Humphreys SC. Minimally invasive lumbar spinal fusion. J Am Acad Orthop Surg 2007;15:321-9.

6. Fourney DR, Dettori JR, Norvell DC, et al. Does minimal access tubular assisted spine surgery increase or decrease complications in spinal decompression or fusion? Spine 2010;35:S57-S65.

7. Lonner BS, Auerbach JD, Estreicher M, et al. Video-assisted thoracoscopic spinal fusion compared with posterior spinal fusion with thoracic pedicle screws for thoracic adolescent idiopathic scoliosis. J Bone Joint Surg 2009;91A:398-408.

8. Newton PO, Shea KG, Granlund KF. Defining the pediatric spinal thoracoscopy learning curve: Sixty-five consecutive cases. Spine 2000;25:1028-35.

9. Osgur BM, Aryan HE, Pimenta L, et al. Extreme lateral interbody fusion (XLIF): A novel surgical technique for anterior lumbar interbody fusion. Spine J 2006;6:435-43.


Brian W. Su, MD, Adam L. Shimer, MD, and Alexander R. Vaccaro, MD, PhD

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