Minimally Invasive Spine Surgery: MISS Techniques

Minimally invasive spine surgery (MISS) aims to achieve the goals of traditional open surgery with smaller incisions, less muscle damage, and faster recovery. It is based on the principle of "performing the same surgery with less damage".

Key Techniques

Tubular Retractor System

Instead of being cut, muscle fibres are pushed aside with dilation tubes. The working channel is generally 14-22 mm in diameter, depending on the system and the targeted area. Muscle damage is dramatically reduced, and postoperative pain is significantly decreased.¹

Screws are placed through 1 cm incisions on the skin under fluoroscopy or navigation guidance.

Percutaneous Pedicle Screw

Screws are placed through 1 cm incisions on the skin under fluoroscopy or navigation guidance. Multi-level stabilisation procedures can be performed with minimally invasive surgical methods using percutaneous pedicle screws.²

Endoscopic Discectomy

The herniated disc material is removed with an 8 mm diameter endoscope. It can be applied via a transforaminal or interlaminar approach. It can even be performed under local anaesthesia.^3,4

Lateral Interbody Fusion (LLIF/XLIF)

The disc space is accessed from the side via a retroperitoneal approach. Anterior vascular structures and posterior nerve structures are preserved. By placing a large cage into the disc space, both height is gained and fusion is achieved.

Robotic-Assisted Surgery

Screw placement is planned and executed with millimetric precision using a robotic arm. Radiation exposure is reduced, and accuracy is increased.^5,6

Advantages

Compared to open surgery, minimally invasive spine surgery provides less blood loss, a shorter hospital stay, a faster return to work, less muscle damage, and less postoperative pain.^7,8

→ Next page: S36 — MISS vs. Open Surgery Comparison