Small is Beautiful, Less is Better

Gun Choi

doi:10.14245/ns.19edi.002

Spine diseases impose significant burdens on the healthcare system. Modernization of society has resulted in lifestyle changes that have caused an increase in the frequency of degenerative spine conditions. Traditionally, surgical management of degenerative spine disorders included major procedures involving very large incisions and soft tissue dissection, resulting in morbidity and even mortality, longer hospital stays, and delayed return to work. In contrast, modern circumstances require patients to return to their activities as early as possible. Therefore, traditional surgical techniques are now less favoured by surgeons and patients.

Minimally invasive spine surgery (MISS) techniques are more acceptable to surgeons and patients because they require smaller incisions with less tissue damage, less blood loss, a shorter hospital stay, and faster patient recovery. Furthermore, with the increase in osteoporosis, fusion surgery is becoming more difficult, especially long fusion surgery. Although MISS requires a longer learning curve and specialised instruments, in contrast to traditional techniques, my experience suggests that the benefits of MISS more than compensate for these drawbacks.

My basic concept of MISS has always been to preserve the facet and intervertebral joint space as much as possible. Preserving joint mobility is the core concept of MISS. To achieve this, my approach has been to isolate the sources of pain and then to target those lesions specifically. Initially, MISS consisted of microscopic and tubular surgery, but in the last decade or so, endoscopic spine surgery has grown significantly beyond lumbar disc herniation to encompass cervical and thoracic disc herniation, low back pain, lumbar stenosis, and even endoscopy-assisted lumbar fusion. MISS is the gateway to the future, as more and more advancements in technology are expanding its indications even further.