Incorporation of MISS in Routine Spine Practice

Volume 2 | Issue 1 | April-September 2021 | page: 01-05 | Amit C. Jhala

Authors: Amit C. Jhala [1]

[1] Department of Spine Surgery, Chirayu Hospital, Vishwakunj Cross Roads, Paldi, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Amit C. Jhala,
Consultant Spine Surgeon, Chirayu Hospital, Vishwakunj Cross Roads, Paldi, Ahmedabad, Gujarat, India.


Traditional open spine surgery is the gold standard procedure in spine practice. Minimally invasive spine surgery (MISS) since last two decades have tremendously improved in technique and technology improving the clinical and functional outcomes of the surgery and patients. But still MISS has steep learning curve, many challenges and hurdles to inculcate it in the routine spine practice of the surgeon who may be either a novice or even an established in spine practice. The author has tried to identify the hurdles in incorporating MISS in routine spine practice and suggested methods to overcome these hurdles to incorporate MISS in routine clinical practice.
Keywords: Minimally Invasive Spine Surgery (MISS); Spine practice; Spine Surgeon.



1. Markatos K, Korres D, Kaseta MK, Karamanou M, Androutsos G, Paul of Aegina (625-690), his work and his contribution to neurological surgery: trephinations and laminectomies in the Dark Ages, World Neurosurgery (2017), doi: 10.1016/j.wneu.2017.10.047.
2. Tarpada SP, Morris MT, Burton DA. Spinal fusion surgery: A historical perspective. J Orthop. 2016;14(1):134-136. Published 2016 Nov 9. doi:10.1016/j.jor.2016.10.029
3. Truumees E. A history of lumbar disc herniation from Hippocrates to the 1990s. Clin Orthop Relat Res. 2015;473(6):1885-1895. doi:10.1007/s11999-014-3633-7
4. Telfeian, A. E., Veeravagu, A., Oyelese, A. A., & Gokaslan, Z. L. (2016). A brief history of endoscopic spine surgery, Neurosurgical Focus FOC, 40(2), E2.
5. Caspar W. A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. In: Wullenweber R, Brock M, Hamer J, editors. Advances in Neurosurgery. Berlin: Springer-Verlag; 1977. pp. 74–7.
6. Yasargil MG. Microsurgical operation for herniated disc. In: Wullenweber R, Brock M, Hamer J, Klinger M, Spoerri O, editors. Advances in Neurosurgery. Berlin: Springer-Verlag; 1977. p. 81
7. Microlumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc. Williams RW. Spine (Phila Pa 1976). 1978 Jun; 3(2):175-82
8. Foley KT, Smith MM. Microendoscopic discectomy. Techniques in Neurosurgery. 1997;3:301–7
9. Vaishnav AS, Othman YA, Virk SS, Gang CH, Qureshi SA. Current state of minimally invasive spine surgery. J Spine Surg. 2019 Jun;5(Suppl 1):S2-S10. doi: 10.21037/jss.2019.05.02. PMID: 31380487; PMCID: PMC6626758.
10. Hammad A, Wirries A, Ardeshiri A, Nikiforov O, Geiger F. Open versus minimally invasive TLIF: literature review and meta-analysis. J Orthop Surg Res. 2019 Jul 22;14(1):229. doi: 10.1186/s13018-019-1266-y. PMID: 31331364; PMCID: PMC6647286.
11. Miller LE, Bhattacharyya S, Pracyk J. Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion for Single-Level Degenerative Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. World Neurosurg. 2020 Jan;133:358-365.e4. doi: 10.1016/j.wneu.2019.08.162. Epub 2019 Aug 30. PMID: 31476471.
12. Schmidt FA, Wong T, Kirnaz S, et al. Development of a Curriculum for Minimally Invasive Spine Surgery (MISS). Global Spine Journal. 2020;10(2_suppl):122S-125S. doi:10.1177/2192568220910711
13. Härtl R. The 6 T’s of Minimally Invasive Spine Surgery. Global Spine Journal. 2020;10(2_suppl):5S-7S. doi:10.1177/2192568220911617
14. Modi HN. Learning Curve for Minimally Invasive Spine Surgeries: A Review of Initial 162 Patients in Five Years of Implementing MISS Technique. Journal of Minimally Invasive Spine Surgery and Technique 2020; 5(2): 43-50.
15. Dushyanth Srinivasan, Khoi D. Than, Anthony C. Wang, Frank La Marca, Page I. Wang, Thomas C. Schermerhorn, Paul Park. Radiation Safety and Spine Surgery: Systematic Review of Exposure Limits and Methods to Minimize Radiation Exposure. World Neurosurgery.Volume 82, Issue 6, 2014, Pages 1337-1343.
16. Kulkarni A., Ruparel S. How to Incorporate Minimally Invasive Spine Surgery in Practice? J Minim Invasive Spine Surg Tech. 2018;3 (1): 9-12.

How to Cite this Article:  Jhala AC | Incorporation of MISS in Routine Spine Practice  | Back Bone: The Spine Journal | April-September 2021; 2(1): 01-05.


(Abstract) (Full Text HTML)      (Download PDF)