Traditional vs. Minimally Invasive Spine Surgeries

When people think of “spine surgery,” a large incision and a surgeon working directly over the opened spine is most likely what they think of. This approach is essentially the traditional (open) spine surgery, where the surgeon uses a larger incision for direct visualization of and access to a larger area. 

Depending on the exact nature of the procedure, open approaches can involve the need to move or even retract (pull aside) muscle and soft tissue to gain direct access to the spine. Generally, in open surgeries, muscles and ligaments may need to be pulled off (and sometimes cut through) to access areas of concern. This greater area of direct exposure is one of the reasons that open approaches are often associated with certain complex cases that need that level of access for imaging and procedures.

In practical terms, open surgery is often described as providing direct, wide visualization of an area. Open approaches are often used with procedures that require extensive decompression, reconstruction, or for multiple levels of the spine. For example, it may be used for spinal reconstruction, severe spinal deformities (like scoliosis or kyphosis), multi-level fusion, and also revision surgeries where existing scar tissues make previous surgery challenging. 

Recovery time varies widely based on the type of diagnosis and the procedure performed, but open surgical approaches are commonly associated with a longer recovery time and increased areas of soft tissue disturbance as compared to a minimally invasive approach.

Understanding Minimally Invasive Spine Surgery

Minimally invasive spine surgery (MISS) doesn’t refer to just one standardized procedure. Instead, it’s considered a category of surgical techniques that use instruments or tools designed to access the spine through smaller incisions and less disruption of the surrounding tissue. 

MISS typically uses incisions of about 1 to 1.5 inches compared with 3 to 4 inches or more for many traditional open spine procedures, which correlates with less muscle disruption and smaller scars. Patients undergoing MISS often leave the hospital the same day or within 1 to 2 days, whereas open procedures more commonly require several days of inpatient stay.

One description emphasizes that while traditional surgery involves cutting tissues, in comparison, MISS techniques work to gently dilate muscle fibers to move them aside instead of relying on cutting through areas. 

Potential benefits associated with this approach include lower levels of soft tissue injury, lower levels of blood loss, decreased length of hospital stay, decreased post-op pain, faster recovery, and faster return to activity and work.

There is also evidence that suggests that while MISS fusion techniques show significant advantages in some factors (like hospitalization length, cost, and time spent before returning to work), this type of approach involves significantly increased X-ray/radiation exposure for the surgeon. Data highlights a trade‑off: minimally invasive techniques expose surgeons to more than ten‑fold higher intraoperative radiation compared with open procedures because of greater reliance on fluoroscopy. Some comparative studies report that while operative times can be similar between minimally invasive and open fusion, once the learning curve is surpassed early in adoption, MISS cases often take longer than open surgeries.

Key Differences: Traditional vs. Minimally Invasive Spine Surgery

A straightforward way to explain the key differences between traditional and minimally invasive spine surgeries is as follows:

1. Incision size and tissue disruption: While MISS techniques often reduce the required areas of disruption by using smaller incisions, open surgery may rely on more significant soft tissue being moved or even cut to achieve successful access and procedure completion.
2. Tools and visualization: Open techniques primarily rely on direct visualization by the surgeon to maintain a wide view, while MISS often involves the use of specialized instruments or devices that enable torso stabilization during the procedure.
3. Hospital stay and early recovery: There are shorter hospital stays after using MISS techniques as opposed to more traditional open surgical techniques.
4. What each approach can treat: Conditions often treated with MISS include herniated discs, sciatica, spinal stenosis, degenerative disc disease, tumors, or fractures. 
   1. Based on evidence, we know that cervical spine surgery minimally invasive approaches for disc herniation can improve short‑term neck pain compared with open procedures, but they do not consistently outperform open surgery in overall function, arm pain relief, or long‑term neck pain. Systematic reviews conclude that minimally invasive cervical and lumbar decompressions do not show clear superiority over open surgery in long‑term patient‑reported outcomes, reinforcing that technique choice should be individualized rather than marketed as universally “better.”
5. Surgeon preference: Technique selection isn’t only about understanding the anatomy or performing a technique safely — it’s about surgeon experience and what approach is safest for each patient. One review in Neurospine summarizes that clinicians may prefer different surgical approaches based on surgical comfort level with various surgeries.

Additionally, practice patterns still favor open surgery: survey research published in 2025 found that open techniques remained the preferred approach in multiple common lumbar scenarios for approximately 42–59% of spine surgeons worldwide, with minimally invasive approaches chosen less frequently despite their perceived benefits. Many surgeons cite concerns about the learning curve, radiation exposure, equipment costs, and the risk of neurologic or dural complications as reasons for continued reliance on open techniques.

Comparing Outcomes: Effectiveness and Long-Term Results

While some studies have shown advantages in morbidity or minimally invasive lumbar fusion with MISS techniques, these advantages can vary significantly by condition. A systematic review did not find evidence supporting treatment with minimally invasive surgery over open surgery for cervical or lumbar disc herniation.

Minimally invasive approaches show some short-term advantages regarding blood loss and hospitalization times when used to treat very specific conditions, but they also present challenges involving requirements for a great deal of exposure to radiation during the procedure. More importantly, open surgery techniques are still crucial for other conditions, especially those involving complex revision processes. 

Who Is a Candidate for Each Approach?

Ultimately, this question provides insight into who might benefit from each approach, but there’s no precise answer as to who would qualify for which procedure. It’s important to weigh the pros and cons of each method with your physician. 

Factors that often influence treatment decisions include:

• Type of condition being treated
• A requirement for decompression
• If the case requires fusion
• Prior spine surgeries
• Practice patterns 

Make an Appointment With Dr. Melamed

Considerations about which approach to use should be determined using your X-rays while considering your goals for surgery alongside your doctor. Make an appointment with Dr. Melamed today to discuss your options and determine which approach is best for you.