Skip to main content

Learning Curve and Complications of Minimally Invasive Spine Surgery

  • Chapter
  • First Online:
Core Techniques of Minimally Invasive Spine Surgery
  • 381 Accesses

Abstract

Minimally invasive spine surgery (MISS) techniques may provide relevant clinical results with less approach-related morbidity than conventional open surgery. These techniques can treat patients with minor complications and have faster recovery times. However, muscle-sparing or bypassing access techniques have some technical hurdles and risks unique to novel approaches, including small surgical exposure, restricted working corridors, and limited surgical devices. The most common complications are dural tears, incomplete decompression, instrument malposition, hematoma, and infection related to a minimally invasive approach. Therefore, surgeons aspiring to perform MISS should overcome the learning curve to achieve technical proficiency and reliable outcomes. Systematic training courses and technological developments should be conducted to overcome these barriers. The present review describes the most common complications of MISS and how to prevent them.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jaikumar S, Kim DH, Kam AC. History of minimally invasive spine surgery. Neurosurgery. 2002;51(5 Suppl):S1–S14.

    PubMed  Google Scholar 

  2. Fessler RG, O’Toole JE, Eichholz KM, et al. The development of minimally invasive spine surgery. Neurosurg Clin N Am. 2006;17(4):401–9.

    Article  PubMed  Google Scholar 

  3. Banczerowski P, Czigléczki G, Papp Z, et al. Minimally invasive spine surgery: systematic review. Neurosurg Rev. 2015;38(1):11–26.

    Article  PubMed  Google Scholar 

  4. Phan K, Rao PJ, Kam AC, Mobbs RJ. Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis. Eur Spine J. 2015;24(5):1017–30.

    Article  PubMed  Google Scholar 

  5. Khan NR, Clark AJ, Lee SL, Venable GT, Rossi NB, Foley KT. Surgical outcomes for minimally invasive vs open transforaminal lumbar interbody fusion: an updated systematic review and meta-analysis. Neurosurgery. 2015;77(6):847–74; discussion 874.

    Article  PubMed  Google Scholar 

  6. Virk SS, Yu E. The top 50 articles on minimally invasive spine surgery. Spine (Phila Pa 1976). 2017;42(7):513–9.

    Article  PubMed  Google Scholar 

  7. Clark AJ, Safaee MM, Khan NR, et al. Tubular microdiscectomy: techniques, complication avoidance, and review of the literature. Neurosurg Focus. 2017;43(2):E7.

    Article  PubMed  Google Scholar 

  8. Vaishnav AS, Othman YA, Virk SS, et al. Current state of minimally invasive spine surgery. J Spine Surg. 2019;5(Suppl 1):S2–S10.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Derman PB, Phillips FM. Complication avoidance in minimally invasive spinal surgery. J Spine Surg. 2019;5(Suppl 1):S57–67.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Weiss H, Garcia RM, Hopkins B, Shlobin N, Dahdaleh NS. A systematic review of complications following minimally invasive spine surgery including transforaminal lumbar interbody fusion. Curr Rev Musculoskelet Med. 2019;12(3):328–39.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ahn Y. Devices for minimally-invasive microdiscectomy: current status and future prospects. Expert Rev Med Devices. 2020;17(2):131–8.

    Article  CAS  PubMed  Google Scholar 

  12. Subramonian K, Muir G. The ‘learning curve’ in surgery: what is it, how do we measure it and can we influence it? BJU Int. 2004;93(9):1173–4.

    Article  CAS  PubMed  Google Scholar 

  13. Bach C, Miernik A, Schönthaler M. Training in robotics: the learning curve and contemporary concepts in training. Arab J Urol. 2014;12(1):58–61.

    Article  PubMed  Google Scholar 

  14. Cook JA, Ramsay CR, Fayers P. Statistical evaluation of learning curve effects in surgical trials. Clin Trials. 2004;1(5):421–7.

    Article  PubMed  Google Scholar 

  15. Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT. Assessment of the learning curve in health technologies. A systematic review. Int J Technol Assess Health Care. 2000;16(4):1095–108.

    Article  CAS  PubMed  Google Scholar 

  16. Benzel EC, Orr RD. A steep learning curve is a good thing! Spine J. 2011;11(2):131–2.

    Article  PubMed  Google Scholar 

  17. Hoppe DJ, de Sa D, Simunovic N, Bhandari M, Safran MR, Larson CM, Ayeni OR. The learning curve for hip arthroscopy: a systematic review. Arthroscopy. 2014;30(3):389–97.

    Article  PubMed  Google Scholar 

  18. Ahn Y, Lee S, Son S, Kim H, Kim JE. Learning curve for transforaminal percutaneous endoscopic lumbar discectomy: a systematic review. World Neurosurg. 2020;143:471–9.

    Article  PubMed  Google Scholar 

  19. Sánchez-Santos R, Estévez S, Tomé C, González S, Brox A, Nicolás R, Crego R, Piñón M, Masdevall C, Torres A. Training programs influence in the learning curve of laparoscopic gastric bypass for morbid obesity: a systematic review. Obes Surg. 2012;22:34–41.

    Article  PubMed  Google Scholar 

  20. Sclafani JA, Kim CW. Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review. Clin Orthop Relat Res. 2014;472:1711–7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Simonson DC, Roukis TS. Incidence of complications during the surgeon learning curve period for primary total ankle replacement: a systematic review. Clin Podiatr Med Surg. 2015;32:473–82.

    Article  PubMed  Google Scholar 

  22. Ahn Y, Lee S, Son S, Kim H. Learning curve for interlaminar endoscopic lumbar discectomy: a systematic review. World Neurosurg. 2021;150:93–100.

    Article  PubMed  Google Scholar 

  23. Maroon JC. Current concepts in minimally invasive discectomy. Neurosurgery. 2002;51(5 Suppl):S137–45.

    PubMed  Google Scholar 

  24. Perez-Cruet MJ, Fessler RG, Perin NI. Review: complications of minimally invasive spinal surgery. Neurosurgery. 2002;51(5 Suppl):S26–36.

    PubMed  Google Scholar 

  25. Nerland US, Jakola AS, Solheim O, et al. Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study. BMJ. 2015;350:h1603.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Karikari IO, Isaacs RE. Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes. Spine (Phila Pa 1976). 2010;35(26 Suppl):S294–301.

    Article  PubMed  Google Scholar 

  27. Heemskerk JL, Oluwadara Akinduro O, Clifton W, Quiñones-Hinojosa A, Abode-Iyamah KO. Long-term clinical outcome of minimally invasive versus open single-level transforaminal lumbar interbody fusion for degenerative lumbar diseases: a meta-analysis. Spine J. 2021;21(12):2049–65.

    Article  PubMed  Google Scholar 

  28. El-Desouky A, Silva PS, Ferreira A, Wibawa GA, Vaz R, Pereira P. How accurate is fluoroscopy-guided percutaneous pedicle screw placement in minimally invasive TLIF? Clin Neurol Neurosurg. 2021;205:106623.

    Article  PubMed  Google Scholar 

  29. Ahn Y, Kim JU, Lee BH, Lee SH, Park JD, Hong DH, Lee JH. Postoperative retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy. J Neurosurg Spine. 2009;10(6):595–602.

    Article  PubMed  Google Scholar 

  30. Ahn Y, Lee SH. Postoperative spondylodiscitis following transforaminal percutaneous endoscopic lumbar discectomy: clinical characteristics and preventive strategies. Br J Neurosurg. 2012;26(4):482–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ahn, Y. (2023). Learning Curve and Complications of Minimally Invasive Spine Surgery. In: Ahn, Y., Park, JK., Park, CK. (eds) Core Techniques of Minimally Invasive Spine Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-19-9849-2_3

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-9849-2_3

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-9848-5

  • Online ISBN: 978-981-19-9849-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics