Half of the surgeries I perform are revision surgeries (repairing failed spine surgeries performed elsewhere).”Minimally Invasive Spine Surgery” is a great marketing tool in name but this surgery type has more failures than any other surgery I am required to revise. For reasons made obvious in the ensuing discussion, “Minimally Invasive Spine Surgery” has many problems. This procedure seems to have been adopted more by neurosurgeons (as compared to spine surgeons) and I can tell you that 80% of the failures I see are “Minimally Invasive Spine Surgery” fusions performed by neurosurgeons.
The idea behind “Minimally Invasive Spine Surgery” is not bad. The typical approach to the spine is a midline incision. This exposes the spine through the area where the muscles join together. Years ago Leon Wiltse (a spine surgeon), developed an approach through two lateral incisions. This made placing pedicle screws much easier (part of the fusion process).
This approach was adopted by the “Minimally Invasive Spine Surgery” developers to mean that there was less dissection of tissues required to perform fusion surgery, therefore “Minimally Invasive”. There were studies that compared this type of surgery to the conventional “open” procedures that my predecessors used. Of course, my predecessors did not appreciate a small incision and minimal dissection so the comparisons were way off the mark and made the “Minimally Invasive Spine Surgery” look better by comparison.
I personally do not like the approach to “Minimally Invasive Spine Surgery” for fusion for a number of reasons. First, the truth is that my minimal incision spine surgery through a central incision is less dissection than their approach. If you measure the two incisions these individuals use vs my one incision, my incisions are at least 25-50% smaller in length. In addition, the incisions they use heal less cosmetically acceptable that a smaller central incision (less width and less scar).
The second disadvantage of the “Minimally Invasive Spine Surgery” is that you do not look at the spine centrally during surgery but only at the periphery (the side). This makes decompression of the spine more problematic.
The third disadvantage is the decreased success rate of “Minimally Invasive Spine Surgery”. Admittedly, I only see failures of surgery in my patient base so I don’t see the successes (as these patients would not find me in the first place). My samples may be skewed. Nonetheless, 80% of the failures I see are minimally invasive surgeries. My fusion rate is 99% (but I also use BMP for many procedures).
Dr. Corenman
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.