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Minimally Invasive Spine Surgery

What Is Minimally Invasive Spine Surgery?

In the past, if surgery was necessary, it was an open spine surgery — no matter the procedure. Open surgeries involve a large incision, which can have a few risks. The large incision cuts muscles and ligaments, destabilizing the back, thus requiring a longer recovery time.

A considerable amount of blood is lost and the wound can become infected, which may require additional surgery. Patients have also suffered significant post-operative pain and required narcotic medicines for several weeks.

To combat these risks, especially for neurosurgery, tubular retractors were developed. Tubular retractors — a microscope or loupes to visualize the spine — were the first way to perform minimally invasive surgeries instead of completely exposing the spine. Minimally invasive spine surgery (MISS) involves accessing the spine so the surgeon can see and perform specific procedures more effectively. These include decompressions, deformity corrections, stabilizations and tumor removals.

Overall, MISS aims to achieve patient outcomes similar to open spine surgery while minimizing blood loss and collateral damage to muscles, soft tissue and ligament attachments. A patient’s benefits of receiving MISS include less pain after surgery, shorter hospital stays, quicker recovery and a faster return to daily activities.

What Types of Spinal Conditions Can Be Treated With MISS?
Spinal Stenosis

The narrowing of the spinal canal, restricting mobility and spinal nerves.

Herniated Disc

When the rubbery cushion between your vertebrae becomes irritated and begins to bulge or shift, putting significant pressure on spinal canal nerves.


Vertebrae joint problems can cause slippage — when a vertebra slides forward over the one below.


The result of concentrated abnormal cell growth in or around the spine. Metastatic tumors are caused by the spread of these abnormal cells from other starting locations in the body.

Bone Spurs

Bony projections that grow on the spinal vertebrae. They aren’t particularly painful until they affect surrounding tissue and nerves.


Any abnormal spine curvature, usually with one curve like the letter C or two curves like the letter S.

Degenerative Disc Disease

This age-related disease can cause intervertebral disc changes like a loss of cushioning, fragmentation and herniation.

Spinal Infections

Infections in another part of the body can travel to the spinal tissues via the bloodstream.

Sciatica (Pinched Nerve)

Several factors can influence sciatica, resulting in a pinched or compressed nerve in the spinal canal’s lower lumbar region.

How Is MISS Performed?

Minimally invasive spine surgery is usually performed through a small 1- or 2-inch incision called a mini-open procedure. Tubular retractors are utilized instead of cutting and stripping soft tissues and major lumbar muscles. After an incision is made, under fluoroscopy — a real-time X-ray — a small metal dilator is inserted into the incision, gently spreading the muscle until the target spinal anatomy is reached. Next, a series of metal cannulas — also called tubular retractors — are placed one after another over the dilator to create an access portal to the spine target anatomy. 

The surgeon then uses a microscope or medical loupes to observe the spinal anatomy within the spinal canal. The surgeon decompresses and relieves the spinal nerves with multiple types of microsurgical instruments. After the surgery, the tubular retractor is removed, allowing the muscle to contract, and the surgeon closes the incision with stitches. 

What Are the Types of Minimally Invasive Cervical Spine Surgery?

Anterior Cervical Discectomy and Fusion (ACDF)

Surgery to remove a degenerated or herniated disc in the neck and fuse the two vertebral bodies together.

Cervical Artificial Disc Replacement

Total disc replacement, removing a diseased cervical disc and replacing it with an artificial one.

Posterior Laminectomy

Treatment for cervical stenosis of any cause, removing the lamina to relieve the upper spinal cord of its narrowed pressure.

Posterior Cervical Foraminotomy
Procedure to alleviate pain or weakness caused by a pinched spinal nerve root.
Posterior Spine Fusion
Commonly performed on patients with a fracture or instability by fusing the vertebrae protecting the spinal cord. Titanium screws and connecting rods are used to stabilize the vertebrae segment to allow a bone fusion to occur.
Posterior Laminoplasty
This surgery is similar to a laminectomy but without lamina removal. A laminoplasty creates a hinge on one side of the lamina and a metallic plate is placed on the other side of the spine to make space.

What Are the Types of MISS for the Lumbar Region?

The following list is similar to the cervical versions of MISS, but these occur in the lumbar or lower region of the spine.
MIS Micro-Discectomy
Surgery to decompress a herniated or bulging spinal disc.
MIS Lumbar Laminectomy
Surgery to relieve pressure and pain on spinal nerves in the spinal canal in your lower back.
MIS Laminotomy
Surgical procedure that addresses spinal stenosis by relieving pressure on spinal nerves.
Lumbar Artificial Disc Replacement
Surgery that completely removes a degenerative lumbar disc and replaces it with an artificial disc that preserves spinal motion.
MIS Lumbar Fusion Surgery

A surgery to permanently fuse two or more vertebrae in your spine, eliminating motion between them. This surgery is performed to correct spinal instability, weakness, deformity and herniated discs. There are several lumbar fusion approaches. These include:

  • Anterior Lumbar Interbody Fusion (ALIF)
  • Posterior Lumbar Interbody Fusion (PLIF)
  • 360 Anterior/Posterior Lumbar Spine Fusion
  • Transforaminal Lumbar Interbody Fusion (TLIF)
  • Extreme Lateral Interbody Fusion (XLIF)
  • Oblique Lateral Interbody Fusion (OLIF)

Who Is a Candidate for MISS?

Spine surgery is often reserved for patients suffering from severe pain that affects their daily activities such as standing, sitting, walking and ability to work. In general, spine surgery is only recommended after patients have exhausted three to six months of conservative treatments — such as over-the-counter anti-inflammatory medicines and physical therapy — and cannot relieve pain. The best candidates for minimally invasive procedures are in good general health, physically active and of a healthy weight. Excessive weight, age and overall poor health can potentially eliminate a patient as a candidate for minimally invasive surgery.

If you have a herniated disc, spondylolisthesis, spinal stenosis or other spinal disc-related problems, you may be a candidate for MISS. This surgery is the next treatment option if non-surgical options have not worked for three months or more. MISS is especially helpful in elderly patients who may not be able to endure open surgery.

What Are the Risks of MISS?

The risks of MISS are not exclusive to this procedure — every surgical procedure has some risks. However, while risks are possible, MISS is a safer option than open surgery.

Some risks include:
  • Unexpected blood loss
  • Infection, no matter how small the incision
  • Possible adverse reaction to the anesthetic
  • Blood clots in the legs
  • Nerve injury
  • Surrounding tissue damage
  • Spinal fluid leak
What Are the Benefits of MISS?

Spine surgery can far outweigh living with pain and the diminishing daily quality of life. For every possible risk, there are even more benefits of performing minimally invasive surgery over open surgery.

Minimally invasive spine surgery is effective at relieving pain for carefully selected patients. Some key benefits include MISS being less traumatic, having fewer complications than open surgery and causing considerably less pain. 

Choosing MISS means:

  • Less anesthesia
  • Less blood loss during surgery
  • Reduced risk of infection
  • Less muscle tissue damage
  • Less pain after surgery
  • A shorter hospital stay and overall recovery time
  • A few small scars vs. a large one

How Do I Prepare for MISS?

Once you and your surgeon agree that minimally invasive spine surgery is the proper treatment, there are a few things that you can begin planning for a successful outcome. The following are some important things you can do to prepare:

Quit smoking

Smoking affects your body’s ability to heal after surgery. Smoking can reduce your bone density or, in the case of a spinal fusion, your bones’ ability to fuse.

Ask your doctor for help, as some medications can help you stop. Quitting smoking can reduce your risk of complications during the procedure. Having surgery may be the motivation to finally quit smoking.

Exercise regularly

Exercise can help your body and muscles stay in shape. A healthy body and strong core muscles can shorten your recovery time to return to an active lifestyle.

Lose weight

For those who are overweight, losing a few pounds before surgery can relieve pressure on your spine and ease recovery.

Any weight loss plan should be discussed with your surgeon or a qualified dietician. Allow yourself ample time to plan weight loss before your scheduled surgery.

Review all medication

Your surgical team will review all the medicines you are taking and recommend which ones must be stopped before surgery.

You may have to stop any non-essential medications and herbal therapies. These medications may interfere with anesthesia or other medications you may be given.

Ask questions about your surgery

The more informed you are about your condition and your surgeon’s surgical plan, the better your expected outcomes will be.

Plan for time off work
Ask your surgeon when you can return to work (administrative vs. manual labor).
What Should I Expect After MISS?

The recovery time with minimally invasive spine surgery is significantly shorter than traditional open surgery. Depending on your general physical health and MISS procedure, full recovery can be two to six months. Post-operative pain should be controlled with medication so that you can go home the same day or the next day. Here is a general list of do’s and don’ts after surgery to facilitate an optimal recovery:

  • Avoid certain physical activities. Avoid activities that can injure your back or incision site. Your surgeon will give you specific instructions on what physical activities are allowed during recovery.
  • Follow instructions for cleaning and maintaining your bandage and incision. If you experience more swelling and pain than usual, excessive pus at the site or a fever, call your doctor for instructions.
  • Only use prescribed doses of pain medications. If medication is not controlling your pain, talk to your doctor before changing the prescribed medicine. Some medications can be habit-forming and should be taken only as prescribed.
  • Start exercising as soon as your surgeon clears you. A body in motion — walking, running and exercise — strengthens muscles, reduces pain, improves blood flow and speeds up recovery time. 
  • Get back to regular routines slowly and carefully. There should be no rush. Know your body and how it responds to pain. When getting back in shape, some pain is to be expected. 
How Long Does It Take to Recover From MISS?

On average, someone who undergoes MISS can have a hospital stay of one to two days. However, there can be some exceptions to this rule. An individual can go home the same day for MIS decompressive surgery, whereas MIS fusion patients stay overnight or for two days. Most patients feel comfortable returning to administrative work after two to three weeks. After four weeks, a surgeon will generally clear decompressive surgery patients for physical activity. An MIS fusion usually has patients returning to their physical activities in around eight weeks.

Results can vary for every individual. Young, healthy and active individuals may have a shorter recovery time than elderly, overweight or inactive patients.

What Signs Should I Look for to Call My Surgeon Immediately?

Recovering from back spine surgery is never an easy process. Patients should expect mild to moderate discomfort and physical limitations during recovery while their body heals.

One should be prepared to know the difference between normal discomfort after back surgery and when something is wrong.

The following signs might warrant a call to your spine surgeon’s office. Call your doctor immediately if you notice any of these signs or symptoms following surgery.

  • You have persistent tingling and numbness.
  • You experience loss of bladder or bowel control — not common after back surgery. However, if you experience these symptoms, please call your surgeon’s office immediately.
  • The fluid leaking from your incision is more than the usual small amount. Severe redness and swelling could be an infection.
  • A fever over 100.4 degrees Fahrenheit is present.
  • The pain is worsening instead of getting better.
Call 911 immediately or go to the emergency room if:
  • You are having trouble breathing.

  • You have a severe headache.

Want to know more about MISS?

For more information or questions about minimally invasive spine surgery, contact Desert Institute for Spine Care today.

1635 E. Myrtle • Suite 400 • Phoenix, AZ 85020
Ph: 602-944-2900 • Fax: 602-944-0064

DISC - Desert Institute for Spine Care