Innovations in spine surgery are opening up new opportunities for patient quality and reducing complications. Surgeons say minimally invasive approaches have reduced wound drainage, infections and instability while enabling same-day discharge.
Four spine surgeons discuss what these shifts look like in practice.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
Next question: What financial pressure is most underappreciated by surgeons who don’t run their own practice?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, Feb. 17.
Editor’s note: Responses were lightly edited for clarity.
Question: Has minimally invasive or endoscopic spine surgery changed your complication profile, for better or for worse?
Jeffrey Carlson, MD. Coastal Virginia Surgery Center (Newport News): We have had great success with minimally invasive spine surgery over the past two decades. As we have developed and refined techniques, the complication profile has changed for the better. With smaller incisions, we have found the wound infection rates have decreased. This is also evident in the larger patients with a thick subcutaneous layer that tends to pool serous fluid. Wound drainage rates have declined and the return to the operating room for washouts has almost entirely disappeared. I attribute this to surgical techniques but would not discount the benefits of same-day surgery. Minimally invasive spine surgery allows patients to be discharged home, recover at home, eat their own food and be in their own environment. Families of patients can be more attentive to wound care and changes in health or behavior than busy hospital staff.
Don Park, MD. UCI Health (Orange, Calif.): Endoscopic spine surgery has completely changed my complication profile for the better. It has allowed my practice to be outpatient since patients have minimal postoperative pain and can ambulate right after surgery. I can rest easy that the patients will not have a surgical site infection or wound complication after surgery. The enhanced visualization of the endoscope allows me to be a safer surgeon since the spinal anatomy is very highly magnified, to an even greater degree than the operative microscope, reducing the risk of dural tears and neurologic injuries. In addition, the endoscope’s small diameter can safely traverse spinal anatomy that was previously difficult to access without violating key structures to accomplish the goals of surgery. I can now avoid spinal fusion in many instances since an endoscope would not risk causing iatrogenic instability and collateral damage from the visualization itself. With the ERAS protocol that I utilize with my endoscopic spine patients, the clinical outcomes are much more predictable with the standardization of the multimodal pain regimen, patient education, and postoperative protocols. Endoscopic spine surgery has absolutely transformed my complication profile and my stress level with my patients.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: For better, when used appropriately. Awake spinal fusion, which I pioneered in Connecticut, has genuinely improved patient outcomes: virtually eliminated general anesthesia complications, significantly reduced hospital stays and narcotic requirements, faster recovery, higher patient satisfaction. These advances represent meaningful progress in how we care for people. However, any new technique has a learning curve, and surgeons committed to excellence must be thoughtful about patient selection during that learning phase.
The technology is genuinely beneficial but it requires the same surgical judgment we apply to any approach, and sometimes traditional methods remain superior for certain cases. The real challenge is external pressure to adopt new techniques quickly rather than master them properly, or to apply them beyond appropriate indications. Surgeons want to offer patients the best care, and these technologies help us do that, but we need space to teach them right and freedom to choose the best approach for each patient without economic pressure driving those decisions.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): As a decades-long adherent of ‘minimally invasive’ surgery and microscopic technique, the complication rate has remained well below nationally accepted standards and metrics. Large health systems and employed specialist models require additional outcome scrutiny and data reporting compared to surgery clinics, especially for larger CMS patient populations. These key reporting requirements changed in April of 2025, whereby the Medicare-Medicaid Plan Reporting (MMP), is more stringent and currently affects Medicare and Workers Compensation recipients combined.
Incidentally, muscle splitting approaches and tubular retraction systems are accepted and limited in their approach, becoming prolonged when complicated scenarios arise, subsequently changing surgical strategies to more accessible routes. Generally speaking, lower complication rates are maintained when proper visualization is achieved.
