Principles and Fundamentals of Minimally Invasive Spine Surgery

BACKGROUND: Minimally invasive spine surgery (MISS) was defined by McAfee et al. in 2010 as a procedural approach that by virtue of surgical technique results in less collateral tissue damage, decreases morbidity, and provides patients with a more rapid recovery relative to traditional procedures. METHODS: We reviewed all of our publications and presentations regarding MISS and summarize the main components and guiding principles to perform MISS as routine standard of care. RESULTS: The 4 T's of MISS is a concept that references the key elements that determine the success of MISS cases. The 4 T's are target (the patient and patient selection), technology (setting of the operation), technique (the surgeon), and teaching/training. CONCLUSIONS: MISS is an advancing field that has rapidly progressed in the past decade, and its role in treating complex spinal pathology will continue to expand. The 4 T's and the 3 technical principles of MISS are requirements for successful MISS. MISS is a dynamic field that is developing in parallel with technology, especially as it impacts imaging and surgical implementation. The ultimate goal of MISS is to achieve spinal health in the least invasive manner while avoiding overtreatment. MISS gives patients the best chance at favorable outcomes and shortest possible recovery course, while minimizing iatrogenic spinal instability.