Growing Trend Toward Minimally Invasive Spinal Techniques

In various surgical subspecialties, the utilization of small surgical corridors to address pathologies has led to the revolutionary development of minimally invasive approaches to spine surgeries. The contemporary spine surgeries have been transformed by these modern minimally invasive surgery (MIS) techniques, enabling spine surgeons to attain the same surgical objectives as open procedures while minimizing the collateral damage associated with traditional approaches. Through the use of MIS techniques, surgeons can circumvent the need for a lengthy incision and extensive muscle dissection. This reduction in tissue injuries has been shown to correlate with decreased blood loss, diminished postoperative pain, shorter hospital stays, and accelerated recovery. Numerous laboratory, imaging, and biomechanical studies have provided evidence that MIS approaches contribute to the reduction of paraspinal muscle atrophy and allow for the greater preservation of normal spinal motion.

Benefits of Minimally Invasive Spinal Approaches 

The rising popularity of minimally invasive spinal surgery techniques can be attributed to their potential benefits, including the following:

• Smaller incisions: Surgeons operate through these smaller incisions without extensive cutting or dissection of muscles, minimizing tissue trauma. This approach not only leads to reduced postoperative pain but also promotes a quicker recovery for patients. The precision afforded by smaller incisions contributes to the targeted and less invasive nature of minimally invasive procedures.
• Quicker recovery time: Minimally invasive procedures offer the potential to significantly reduce hospital stays. While the specific duration varies based on the patient and the procedure, patients undergoing minimally invasive surgery (MIS) typically return home within 1 to 2 days, in contrast with the 3 to 5 days often required for traditional surgeries. The expedited recovery time is a notable benefit, allowing patients to resume their daily activities sooner.
• Lower risk of infection: Smaller incisions play a crucial role in minimizing the exposure of the surgical site to external contaminants, thereby reducing the risk of postoperative infections. This advantage underscores the importance of the meticulous and less invasive approach associated with minimally invasive techniques.
• Reduced blood loss: Minimally invasive procedures are characterized by less blood loss compared to open surgeries. This reduction in blood loss not only diminishes the need for blood transfusions but also mitigates associated complications, promoting a safer surgical experience for patients.
• Improved cosmetic outcome: The use of smaller incisions in minimally invasive procedures results in less conspicuous scars, contributing to an enhanced cosmetic outcome for patients. This aesthetic benefit is particularly significant for individuals who prioritize the cosmetic aspect of their surgical experience.
• Less postoperative pain: Minimally invasive techniques are associated with decreased postoperative pain due to the reduced trauma to tissues. While some discomfort may still be expected, advancements in pain control measures facilitate more effective management and alleviation of pain, ensuring a more comfortable recovery for patients.
• Better preservation of spinal stability: Minimally invasive approaches prioritize the preservation of spinal stability while addressing underlying issues. This approach reduces the reliance on extensive hardware and fusion, offering a balance between addressing the spinal condition and maintaining the natural stability of the spine. This preservation contributes to long-term spinal health and functionality.

These advantages collectively explain the higher growth rate of overall minimally invasive procedures compared to conventional open spine surgeries, as depicted in the bar chart below. The positive outcomes associated with smaller incisions, quicker recovery, reduced infection risk, lower blood loss, improved cosmetic results, decreased postoperative pain, and enhanced spinal stability contribute to the increasing preference for minimally invasive techniques in the medical field.

Conditions Treated Using MIS Procedures

• Degenerative disc disease
• Herniated disc
• Lumbar spinal stenosis
• Spinal deformities such as scoliosis
• Spinal infections
• Spinal instability including spondylolisthesis
• Vertebral compression fractures
• Spinal tumors

MIS Fusion Procedures

• Minimally invasive lateral interbody fusion (LLIF)
• Minimally invasive oblique lateral interbody fusion (OLIF)
• Minimally invasive posterior lumbar interbody fusion (MIPLIF)
• Minimally invasive transforaminal lumbar interbody fusion (MITLIF)
• Minimally Invasive posterior thoracic fusion

Placement of Screws and Rods

Pedicle screws serve as a method for stabilizing a spinal level in the context of a fusion procedure. While the screws do not directly fixate the levels, they serve as robust anchor points that can be interconnected with a rod. These pedicle screws can be strategically positioned at two or more consecutive spine levels. Following their placement, a short rod is implanted to establish a connection between the screws. This construct of screws and rods effectively restrains motion at the fused levels, contributing to the stability and support required during the fusion process. 

Minimally invasive surgery procedures, utilizing pedicle screws, can be divided by device type into retractor cannulated, retractor non-cannulated, and percutaneous procedures. All three segments are projected to experience growth over the forecast period, leading to a significant surge in the value of the minimally invasive pedicle screw market in Europe.
 


The selection of the most suitable procedure hinges on the individual patient’s characteristics, the spinal condition’s nature, and the surgeon’s expertise. Transforaminal lumbar interbody fusion stands out as the predominant minimally invasive interbody technique, representing over half of all MIS procedures. This prevalence can be attributed to its effectiveness in decompression, customization options, versatility, and clinical success. Following this, posterior lumbar interbody fusion, lateral lumbar interbody fusion, and oblique lateral interbody fusion are subsequent choices in the sequence.

Market Limiters for Minimally Invasive Spinal Implant Market

Motion Preservation

Motion preservation devices offer an alternative to fusion that allows for the preservation of motion in the indicated spinal segment. As more motion preservation devices, such as facet arthroplasty and nucleus replacement, emerge in the European market, the growth of the spinal fusion market will be increasingly limited by these devices.

Surgical Complexity

A significant limiter for MIS fusion is the complexity of the procedures and the skill required to master them. This is particularly true for percutaneous techniques, which use complex tubular apparatuses. Percutaneous techniques and, to a lesser extent, retractor techniques are considered by many to be more difficult to master than traditional open surgical methods. Older generations of doctors and surgeons are especially reluctant to switch to minimally invasive procedures, as it requires a considerable time investment to master the procedure.

Reimbursement

Minimally invasive procedures are more expensive than open surgery, but coverage determinations and reimbursement levels are essentially identical to those of traditional spinal fusion. This will hinder the market until the reimbursement landscape of MIS fusion in Europe is ameliorated or the ASPs of minimally invasive procedures fall to levels similar to those of traditional spinal fusion. 

Conclusion

The minimally invasive approach to surgical procedures, especially in spinal interventions, presents a revolutionary paradigm with numerous advantages. Focusing on smaller incisions, decreased tissue trauma, and accelerated recovery, this method significantly improves patient outcomes and comfort levels. Additionally, the reduced risk of infections, minimized blood loss and enhanced cosmetic outcomes add to the appeal of minimally invasive techniques. Nonetheless, certain limitations, such as regulatory and reimbursement challenges, exist. However, these drawbacks are offset by the substantial advantages offered by this innovative approach.

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Hanieh Valipour is a research analyst at iData Research, specializing in the spinal implant device and procedure Market. She leads research projects focused on spinal implants and minimally invasive procedures and devices, with a particular emphasis on the European market.
Kamran Zamanian, Ph.D., is the CEO and founding partner of iData Research. He has spent over 20 years working in the market research industry with a dedication to the study of medical devices used in the health of patients all over the globe.