Complication Management With Minimally Invasive Spine Procedures

Namath S. Huss ain, M.D.; Mick J. Perez-Cruet, M.D., M.S.


Neurosurg Focus. 2011;31(4):e2 

In This Article

Abstract and Introduction


Spine surgery as we know it has changed dramatically over the past 2 decades. More patients are undergoing minimally invasive procedures. Surgeons are becoming more comfortable with these procedures, and changes in technology have led to several new approaches and products to make surgery safer for patients and improve patient outcomes. As more patients undergo minimally invasive spine surgery, more long-term outcome and complications data have been collected. The authors describe the common complications associated with these minimally invasive surgical procedures and delineate management options for the spine surgeon.


With recent advances in technique and access instrumentation, minimally invasive spine surgery has ushered in a renaissance in spine care. Surgeons are becoming more comfortable with these procedures, and industry-surgeon collaborations have provided a plethora of new products to make surgery safer for patients and improve patient outcomes. As more patients receive minimally invasive spine surgery treatments, stronger long-term outcome data are supporting this change in practice pattern.[20,21] Patient outcomes are improved compared with traditional open surgery and costs are reduced, partly due to reduced hospital stays and recovery times. Approach-related morbidity is significantly reduced because normal anatomical structures are preserved to a greater extent, reducing the incidence of delayed progressive deformity and degenerative changes. Minimally invasive surgical procedures of the spine can be just as efficacious as traditional open procedures with respect to the operative pathology. Unnecessary approach dissection and ligamentous and muscular disruption are minimized, potentially leading to a reduced incidence of repeated operations and scar formation.

However, minimally invasive surgical procedures require specialized surgeon training and offer many new technical challenges. Adequate training and familiarity with the microsurgical anatomy through retractor ports, coupled with the appropriate level of surgeon skill and manual dexterity, are critical for procedural success. Training courses, specialized fellowship training, animal and cadaveric dissections, and technique guides are all available to help educate surgeons, improve patient outcomes, and reduce complications.

Endoscopic optics, although improving, can limit 3D image representation and provide imperfect color representation. Tissues of similar color and structure are difficult to differentiate, such as nerve roots and the ligamentum flavum. Surgeons mistaking these structures could encounter intraoperative complications such as dural tears or nerve root injury. Recent developments in tubular retractors, which can reduce the need for thoracoscope or endoscope use, permit 3D visualization through loupe magnification and/or the operating microscope. However, these ports expose only a small portion of the spine and relevant anatomy; therefore, surgeons must have a clear understanding of the surrounding anatomy and possible complications that can occur with each approach. Understanding and thus avoiding possible complications are critical in making minimally invasive spine surgery safe and effective.