Choice of Minimally Invasive Approaches: A Review of Unique Risks and Complications

  • William P. Mosenthal
  • Srikanth N. Divi
  • Jason L. Dickherber
  • Michael J. LeeEmail author


The goal of minimally invasive spine surgery is to obtain outcomes equivalent or superior to that of open procedures through a less morbid approach that features minimal disruption to the patient’s native anatomy. Tubular retractor systems and microscopes have become staples in the armamentarium of the minimally invasive spine surgeon and, as with any technological innovation, come with their own set of advantages and disadvantages.

Working through a smaller surgical footprint makes mastery of the local anatomy of paramount importance. Many of the anatomical structures that surgeons rely on for reference during open approaches are not visible during minimally invasive approaches and can lead to surgeon disorientation. It is crucial that surgeons develop the ability to convert two-dimensional microscopic images to a three-dimensional representation of the surgical field.

Minimally invasive spine surgeons have to adjust to the changes in control and tactile feedback afforded by the longer instruments required to work through narrow tubular retractors. Complications that occur during the approach, injury to the dura or vascular structures, for example, can be more difficult to manage within the confines of a minimally invasive approach.

Minimally invasive surgeries (MIS) are technically demanding procedures that have a substantial but surmountable learning curve. The onus is on the minimally invasive spinal surgeon to develop a clear understanding of the complications associated with the various minimally invasive approaches and develop the ability to mitigate the risk of complications and manage them if they do occur.


Approach complications MIS approach MIS complications ACDF approach ACDF complications Transpleural approach Transpleural complications Retropleural approach Retropleural complications Arthrodesis approach Arthrodesis complications Foraminotomy approach Foraminotomy complications Laminotomy approach Laminotomy complications Laminoforaminotomy approach Laminoforaminotomy complications Discectomy approach Discectomy complications Microdiscectomy approach Microdiscectomy complications Transforaminal approach Transforaminal complications TLIF approach TLIF complications PLIF approach PLIF complications Transpsoas approach Transpsoas complications DLIF approach DLIF complications XLIF approach XLIF complications LLIF approach LLIF complications ALIF approach ALIF complications OLIF approach OLIF complications ATP approach ATP complications AxiaLif approach AxiaLif complications Presacral approach Presacral complications Interbody approach Interbody complications Posterior approach Posterior complications Anterior approach Anterior complications Cervical approach Cervical complications Thoracic approach Thoracic complications Lumbar approach Lumbar complications 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • William P. Mosenthal
    • 1
  • Srikanth N. Divi
    • 1
  • Jason L. Dickherber
    • 1
  • Michael J. Lee
    • 1
    Email author
  1. 1.Department of Orthopaedic Surgery and RehabilitationUniversity of Chicago Medical CenterChicagoUSA

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