What is Minimally Invasive Spine Surgery?

What is Minimally Invasive Spine Surgery?

Minimally invasive spine surgery represents a surgical philosophy to minimize soft tissue damage that normally occurs during surgery. This involves not only making smaller incisions, but also limiting the amount of soft tissue disruption beneath the skin. While the incisions may be considerably smaller than standard incisions, the procedure performed is essentially the same. This significantly reduces post-operative pain and provides a much faster recovery. In addition, infection rates are significantly lower with minimally invasive techniques. Traditional approaches often disrupt the blood supply to soft tissues. This can cause cells to die (necrosis) creating the perfect environment for bacteria to grow. With minimally invasive techniques, surgeons dilate thru muscle with a series of dilators in order to place a tube. The dilators are then removed and surgery is performed through the tube using a microscope and specialized instruments.  This preserves blood flow to muscles and minimizes post-operative pain. Advances in surgical techniques as well as equipment allow surgeons to perform minimally invasive surgery for many procedures that were never thought possible.

  • Am I a candidate for Minimally Invasive Surgery?

    Most patients are candidates for minimally invasive spine surgery. Over 95% of Dr. Stone’s surgeries are performed using minimally invasive techniques. Occasionally a patient is better served with a more traditional approach. Spine surgery is currently going thru a transformation as an increasing number of surgeons appreciate the benefits and learn the techniques of minimally invasive spine surgery. Switching from traditional approaches can be difficult for surgeons who never learned minimally invasive techniques in their training. Minimally invasive spine surgery requires operating thru a small tube or retractor with the help of a microscope and specialized instruments. This requires a different skill set and is technically more challenging than traditional approaches. It will take over a decade before minimally invasive spine surgery becomes the standard of care. As more surgeons learn minimally invasive techniques, open spine surgery will largely become a thing of the past.

  • How is Minimally Invasive Surgery performed?

    The preoperative process for minimally invasive spine surgery is unchanged from standard techniques. Following a thorough preoperative screening based on your age and anesthesia protocol (i.e., laboratory studies, EKG and chest x-ray) you will be admitted to the operating room pre-anesthesia area (inpatient or outpatient) and interviewed by the nursing and anesthesia staff.  A general anesthetic is typically administered and you are positioned on the operative table in accordance with the procedure to be performed.


    Minimally invasive techniques rely heavily upon the use of intra-operative x-ray equipment (image intensifiers, also known as c-arms). A microscope typically provides illumination and visualization. In addition, your surgeon may also choose to use neurologic monitoring to reduce the risk of nerve injury. This allows your surgeon to receive feedback regarding any nerves which may be stressed during surgery. The operative site is identified and the surgical procedure is performed.


    Many traditional procedures require making large midline incisions that strip muscle from the spine. Minimally invasive techniques require much smaller incisions. What constitutes minimally invasive spine surgery is sometimes unclear. However, the most common definition is operating thru a tube. To perform this, a series of dilators are used to spread muscle instead of cutting it. A tube is then placed over the last dilator. The inner dilators are then removed. The diameter of the tube placed is usually smaller than the diameter of a quarter. Specialized instruments are then placed thru the incision to perform the procedure. Once surgery is complete, the tube is removed and the incision is closed. Depending on your surgery, you may have more than one incision. You are awakened from the general anesthetic and transferred to the post-anesthesia recovery area for further monitoring.

  • Are there risks associated with Minimally Invasive Surgery?

    All surgery carries risk. Potential complications associated with minimally invasive surgery are similar to traditional open approaches. However, infections are far less common with minimally invasive techniques since you do not cut muscle. When you cut muscle, it can lose it’s blood supply leading to cell death (necrosis). This creates the perfect environment for bacteria to grow. In addition, most open spine surgery is performed with Loupes (glasses with a magnifying glass) which magnify objects 2.5x. Minimally invasive techniques most often use a microscope which magnify objects 10x. This increased magnification significantly reduces the risk of nerve damage.