Philosophy and Concepts of Modern Spine Surgery

Abstract

The main goal of improving pain and neurological deficit in the practice of spine surgery is changing for a more ambitious goal, namely to improve the overall quality of life and the future of patients through three major actions (1) preserving the vertebral anatomical structures; (2) preserving the paravertebral anatomical structures; and (3) preserving the functionality of the segment. Thus, three new concepts have emerged (a) minimal surgery; (b) minimal access surgery; and (c) motion preservation surgery. These concepts are covered in a new term, minimally invasive spine surgery (MISS) The term “MISS” is not about one or several particular surgical techniques, but a new way of thinking, a new philosophy. Although the development of minimally invasive spine surgery is recent, its application includes all spine segments and almost all the existing conditions, including deformities.

Evidence-based medicine (EBM), a term coined by Alvan Feinstein in the 1960s (Feinstein A (1964) Annals of Internal Medicine 61: 564–579; Feinstein A (1964) Annals of Internal Medicine 61: 757–781; Feinstein A (1964) Annals of Internal Medicine 61: 944–965; Feinstein A (1964) Annals of Internal Medicine 61: 1162–1193.), emphasizes the possibility of combining art and science following the strict application of scientific methods in the treatment of patients (Feinstein A (1964) Annals of Internal Medicine 61: 944–965; Feinstein A (1964) Annals of Internal Medicine 61: 1162–1193.), which may represent the advantages of objectivity and rationality in the use of different treatments (Fig. 11). However, EBM has many obvious defects, especially in spine surgery it is almost impossible to develop double-blind protocols (Andersson G, Bridwell K, Danielsson A, et al (2007) Spine 32: S64–S65.). In most cases, the only evidence one can find in the literature is the lack of evidence (Resnick D (2007) Spine 32:S15–S19.), however, the lack of evidence does not mean its absence. Only then, with a rigorous self-analysis, we may take a clear path towards a new philosophy in spine surgery. Of course, feedback from patients through satisfaction and clinical scales can guide our direction and provide the energy needed to maintain the enthusiasm (Fig. 12).