Minimally invasive spine surgery

For the past few decades, significant emphasis across the various surgical specialties has been placed on achieving surgical goals through smaller incisions and with the least amount of collateral damage. This shift from traditional open surgery to minimally invasive surgery is most evident in general surgery, in which cholecystectomies, the most commonly performed procedures, are done laparoscopically in 96% of cases (Tsui et al. Surg Endosc 27:2253-2257, 2013). In spine surgery, technological advances in image guidance, instrumentation, and magnification and illumination have allowed for the adoption of the minimally invasive approach to the wide spectrum of spine pathologies from the craniovertebral junction to the pelvis. The main tenant of minimally invasive spine surgery (MISS) is to achieve the desired outcome, whether it is decompression and/or stabilization, by causing the least amount of soft tissue disruption. This has been accomplished through various ways, including percutaneous, endoscopic, and microscopic techniques. In this chapter, we will discuss the history as well as current state of percutaneous and microscopic MISS by anatomic region, beginning in the thoracolumbar spine then moving rostrally to the craniovertebral junction. Endoscopic spine surgery will be discussed in the next chapter.