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?

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

Learn more about herniated discs

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.

Learn more about spinal tumors

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

Learn more about bone spurs

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

Learn more about scoliosis

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

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

Learn more about sciatica

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. 

Dr. Chris Yeung minimally invasive spine surgery

What Are the Types of Minimally Invasive Cervical Spine Surgery?

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

Learn more about ACDF

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

Learn more about Cervical ADR

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

Procedure to alleviate pain or weakness caused by a pinched spinal nerve root.

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.

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.

Surgery that completely removes a degenerative lumbar disc and replaces it with an artificial disc that preserves spinal motion.

Learn more about Lumbar ADR

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

Learn more about Lumbar Fusion Surgery

Transforaminal lumbar interbody fusion (TLIF) resembles spinal fusion surgery, treating lower back disc problems. TLIF is a more advanced version of other back surgeries, resulting in a typically shorter recovery time.

Learn more about Transforaminal Lumbar Interbody Fusion

Who is a Candidate for MISS?

The candidacy for minimally invasive spine surgery depends on several factors, including the specific condition being treated, the patient’s overall health, and the surgeon’s expertise. Generally, the following individuals may be considered candidates for minimally invasive spine surgery:

  • Patients with specific spinal conditions: Individuals with herniated discs, spinal stenosis, degenerative disc disease, spinal instability, or certain spinal deformities may be candidates for minimally invasive spine surgery. However, the suitability of the procedure depends on the severity and location of the condition.
  • Patients who have exhausted non-surgical treatments: Minimally invasive spine surgery is often considered after non-surgical treatments such as physical therapy, medications, and injections have failed to provide adequate relief.
  • Patients with stable medical conditions: Candidates for minimally invasive spine surgery should generally have stable medical conditions, such as well-controlled diabetes, heart disease, or high blood pressure. However, each case is evaluated individually, and the surgeon will consider the patient’s overall health status.
  • Patients without extensive prior surgeries: Patients who have not undergone extensive spinal surgeries in the past may be better suited for minimally invasive procedures. Previous surgeries can create scar tissue and other complexities that may affect the feasibility of minimally invasive techniques.
  • Patients without contraindications: Certain conditions, such as severe obesity, active infections, or bleeding disorders, may be contraindications for minimally invasive spine surgery. The surgeon will evaluate the patient’s medical history and perform preoperative assessments to ensure their suitability for the procedure.

It’s important to note that the decision for minimally invasive spine surgery is made on an individual basis by a qualified spine surgeon after a thorough evaluation of the patient’s specific condition and medical history.

Dr. Fields minimally invasive spine 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:


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 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.

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.

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.

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

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.
surgeons performing surgery

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.
Man rubbing his neck in pain after being in an auto accident

Call 911 immediately or go to the emergency room if:

  • You are having trouble breathing.

  • You have a severe headache.

Dr Abrams explaining spine x-ray Dr. Abrams laughing

Want to know more about MISS?

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


Our spine health blog features up-to-date spine education and expert spine tips from our spine specialists here at DISC.