20 things to know about minimally invasive spine surgery


With the minimally invasive spine surgery market predicted to grow at a compound annual growth rate of 7.57 percent between 2016 and 2020, there's much to look forward to.

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Here are 20 things to know about minimally invasive spine surgeries:


1. MIS spine surgery techniques allow surgeons to see and treat injuries or disorders without retracting or damaging nearby muscles, according to the American Association of Neurological Surgeons.


2. Patients often feel less pain and experience fewer complications during and after MIS procedures and their hospital stays are typically shorter than patients who undergo open surgery. Kern Singh, MD, co-founder of Chicago-based Minimally Invasive Spine Institute at Rush compared minimally invasive and open spine procedures and concluded that open surgery takes three hours compared to the 75-minute minimally invasive procedure. In addition, Dr. Singh found that open spine surgery is associated with between 400 and 500 mL of blood loss while patients who underwent minimally invasive procedures reported 40 to 50 mL of blood loss.


3. Minimally invasive techniques have been successfully applied to the cervical spine, thoracic spine and the lumbar region since the 1990s, when MIS decompression and spinal fusion procedures were first carried out successfully, according to an article published in The Journal of Neurosurgery.


4. The market for MIS spine surgery is expected to grow at a CAGR of 7.57 percent between 2016 and 2020, according to Market Reports World. According to a Technavio report, minimally invasive spine surgery is growing in popularity. The market was valued at $3 billion in 2015 and the value is expected to hit $4.45 billion by 2020.


5. Surgeons have adopted surgical techniques from a wide variety of medical fields in order to improve MIS procedures and advances in laser, endoscope and image-guidance systems have aided MIS progressions.


However, a majority of surgeons still perform open procedures; MedStar Georgetown University estimates around 10 percent to 20 percent of spine surgeries are performed minimally invasively nationwide, but surgeons at the hospital perform 80 percent of their cases with MIS techniques.


6. Robotic systems can play a key role in MIS procedures, particularly in the accuracy of screw placement and reproducibility of outcomes for spine procedures. While controlling a robotic system during surgery, surgeons have the benefit of seeing a 3-D image on a console, according to Hopkins Medicine. The highly advanced computer software system allows them to make extremely precise movements.


The worldwide spine surgery robotics market is valued at $26 million and expected to reach $2.77 billion by 2022, according to Researchmoz. Robotic guidance can reduce complication rates from the 12.8 percent (freehand) to 4 percent, as shown by a recent study.


7. Endoscopic spine surgery is another technique MIS spine surgeons use. During this type of procedure, the surgeon inserts a thin, flexible tube with a video camera through a small incision or natural opening into the body. The tube is equipped with surgical tools and a camera that displays the live feed for the surgeon on a monitor.


The American Medical Association's CPT 2017 Codebook included the first endoscopic spinal surgery. The code covers endoscopic decompression of the spinal cord, nerve root and more.


8. Minimally invasive surgeries, such as microscopic lumbar disectomy, outpatient lumbar fusions, outpatient cervical fusion and other small incision operations, are ideal for athletes looking to get back to their top playing shape. Many surgeons have performed MIS procedures on professional athletes:


  • Charles Rich, MD, has performed minimally invasive spine surgery on golfer Tiger Woods.
  • Luis Manuel Tumialan, MD, performed minimally invasive spine surgery on former Olympic swimmer Amy Van Dyken-Rouen.
  • Christopher Yeung, MD, performed spine surgery on MLB pitcher Brett Anderson of the Chicago Cubs.
  • Joseph Maroon, MD, performed spinal fusion on former Green Bay Packers tight end Jermichael Finley.
  • Robert Watkins III, MD, and Robert Watkins IV, MD, performed a single-level anterior cervical fusion on former Indianapolis Colts and Denver Broncos quarterback Peyton Manning's disc herniation.


9. According to Newport Beach, Calif.-based Newport Orthopedic Institute, the SPORT study showed that between 85 percent and 100 percent of professional athletes returned to their pre-surgery abilities after a minimally invasive lumbar discectomy and a recovery period between 2.8 months and 8.7 months.


10. The MIS spine device market is projected to grow at a CAGR of 9.1 percent between 2016 and 2021, climbing from a $13.89 billion worth to $21.47 billion over the forecast period.


11. Global companies who play major roles in the MIS spine device market are Ireland-based Medtronic; New Brunswick, N.J.-based Johnson & Johnson; Kalamazoo, Mich.-based Stryker Corp.; and U.K-based Smith & Nephew.


12. In 2015, Marietta, Ga.-based Amendia acquired Parsippany, N.J.-based Custom Spine, increasing its MIS spine product portfolio.  On Feb. 22, 2017, Austin, Texas-based Wenzel Spine acquired Addison, Texas-based OsteoMed's PrimaLOK SP Interspinous System and its PrimaLOK FF Facet Fixation System. Both platforms help treat lumbar spinal disorders and Wenzel Spine intends to integrate them into its developing MIS pipeline.


On June 7, 2016, Warsaw, Ind.-based Zimmer Biomet bought France-based LDR, a medical device company with sales of $164.5 million in 2015, according to Bloomberg. The acquisition strengthened Zimmer Biomet's MIS disc replacement and spinal fusion portfolio.


13. Digital fluoroscopy, image guidance, high resolution endoscopy and minimally invasive surgical tools all play a vital role in conducting minimally invasive spine surgery. In addition, a recent study shows that patients benefit from a 61.6 percent to 83.5 percent radiation reduction when they undergo cannulation and K-wire placement procedures.


14. According to the American Academy of Orthopaedic Surgeons, tubular retractors create passageways for the surgeon to reach problematic areas in the lower back while operating microscopes illuminate and magnify the target areas during procedures.


15. Minimally invasive techniques can't treat everything or everyone, according to Cleveland Clinic. Many minimally invasive spine surgeons limit their practice to otherwise health patients under a certain BMI, ASA score and age.


16. Dr. Singh recently founded the Minimally Invasive Spine Study Group. MISSG is a multi-institutional organization that promotes research and advancement of MISS and houses REDCAP, an online patient registry containing data from 3,000 patients treated with MIS techniques.


17. The Society for Minimally Invasive Spine Surgery was formed in 2007. The organization strives to define and advance the field of minimally invasive spine surgery. Greg Anderson, MD, serves as international chairperson; William Taylor, MD, is the founder and current education chair; Kevin Foley, MD, is the research chair; Larry Khoo, MD, currently serves as marketing chair; Roger Härtl, MD, is centers of excellence chair and Frank Phillips, MD, is regional chair (North America).


The organization advocates on behalf of education, clinical research and documentation, marketing, MIS centers of excellence and governance as they pertain to the ever-evolving MIS field.


18. MIS is more cost effective than open spine surgery, according to a 2011 study published in SAS Journal, now known as the International Journal of Spine Surgery. The study showed that minimally invasive transforaminal lumbar interbody fusion was $14,183 on average while open lumbar fusion came out at $18,633.


A separate study found total inflation-adjusted acute hospitalization costs averaged at $20,187 for one-level MIS procedures, whereas open surgeries costs averaged out at $29,947.


19. Radiation exposure is a concern for spine surgeons and OR teams. A study published in The Journal of Spinal Disorders and Techniques examined radiation exposure during transforaminal lumbar interbody fusion, comparing MIS and open techniques. The study authors found average fluoroscopy time during the open procedure was 39.42 seconds, compared to 94.21 seconds during MIS procedures.


Patients who underwent the MIS procedure were exposed to 2.4-fold more radiation than the open surgery patients. The increased radiation exposure could be tolerable for patients, concluded the study authors, but surgeons performing a high volume of these procedures throughout their career are taking precautions to limit exposure.


20. All spine surgeries performed in ASCs are MIS. Between 1994 and 2006, procedures for intervertebral disc disorders increased 540 percent and spinal stenosis procedures increased 926 percent. During the same time, intervertebral disc disorder cases in ASCs jumped 340 percent. Lumbar disc disease was the most common diagnosis for spine patients during this time period.


More MIS articles:

Minimally Invasive Spine Study Group's goal? Data-drive MIS spine care

5 key notes on MIS vs. open technologies for lumbar spinal fusion

Joimax earns full product registration in Thailand: 5 highlights

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