Although still debated, minimally invasive spine surgery is gaining popularity with the flow of new research espousing its benefits.
"There are still skeptics, as well, which is healthy because as physicians we should always hold ourselves to asking for proof of benefit when we consider changing our standards of 
care," says Society for Minimally Invasive Spine Surgery President Greg Anderson, MD, of Philadelphia-based Rothman Institute.
Research supporting MIS spine has boosted the technique's reputation, highlighting potential benefits:
- Less pain
- Lower infection and complication rates
- Less blood loss: According to a recent Spine study, patients undergoing minimally invasive fusions experienced lower blood loss (88.7 percent lower) than the open procedure group.
- Shorter hospital stays: The hospital stays among the minimally invasive group were 64 percent shorter than hospital stays in the open procedure group, according to a Spine study.
- Quicker recovery
"Research is the key to guiding the perceptions of the spinal community," Dr. Anderson says. "Our society was formed on the premise that education and research could and would improve the quality of the minimally invasive spinal care available to patients and enhance patient outcomes with spinal surgery."
SMISS continues to establish a standardized, high quality of care for spinal patients, by teaching surgeons common MIS principles.
Standardizing MIS principles proves challenging, says Dr. Anderson, as training and practice experiences vastly differ across the world. SMISS constantly strives to offer fresh and valuable educational opportunities to members.
From a technical standpoint, surgeons must become proficient in various surgical approaches to create a safe and effective operating room environment. Logistically, MIS requires excellent equipment and an exceptionally trained staff. Systemic challenges associated with MIS surgeries involve support from institutions, payers and referring physicians as well as the spinal community.
"These [MIS] techniques still make up only a fraction of the spinal care provided today," says Dr. Anderson. "The reason for this is largely due to surgeon training."
Surgeons tend to remain loyal to the surgical techniques they learned during their residencies and fellowships, and accept new surgical techniques slowly. Adopting new techniques introduces room for complications, and this risk deters many surgeons.
"SMISS is trying to create a venue for gradual, life-long learning that will enhance the skill set of both novice and highly skilled surgeons," says Dr. Anderson. By standardizing the training process, SMISS hopes to ease the learning curve and therefore limit risk to patients.
Residency and fellowship training is starting to expose the next generation of spine surgeons to MIS, which will establish more competency in the technique as they enter the industry.
"The best way to learn new techniques is through a structured, supervised process with graduated responsibility," says Dr. Anderson. After initial exposure, he recommends surgeons attend courses involving didactic learning and cadaver training or observe practicing MIS surgeons.
The MIS technique will likely gain more traction in lumbar fusion procedures. Surgeons perform many lumbar fusions for degenerative conditions, mild deformities and trauma, and the MIS technique has the potential to lower morbidity compared to the open approach.
Noteworthy data supporting the MIS approach for significant thoracolumbar deformities and cervical spine surgery does not yet exist. However, Dr. Anderson believes as new technologies emerge, these procedures will benefit from the MIS technique.
The future of MIS spine will also depend on developing technologies for visualization and navigation as well as biologics and implant development.