Open vs. minimally-invasive spinal surgery: which is better?

There are pros and cons to both open and minimally-invasive approaches, states Mr Richard Selway, a leading neurosurgeon at the London Neurosurgery Partnership.

What is open spine surgery?

Open spine surgery is the term we now use to refer to traditional surgical techniques for accessing the spine. Typically, a large incision is made – usually 5-6 inches across – in order to give us enough of a view of the spine, spinal cord and the muscles around it.

There are a number of advantages to open surgery:

• It’s practiced much more widely – almost all spine surgeons will have experience with open techniques, so as a patient this gives you much more choice. Minimally-invasive spinal surgery, on the other hand, is much more technical – and practised by only a handful of surgeons.
• It’s sometimes necessary for complex operations – more challenging spinal conditions need to be visualised properly for the operation to be successful, and for some of these only open surgery can achieve this

What is minimally-invasive spine surgery?

Minimally-invasive spine surgery uses advanced technology to implement innovative techniques to access the spine.

With the use of specialised instruments, and imaging technology, we can access the area we want to operate on through an incision as small as a few centimetres across. This is significantly smaller than the incision we would make during a traditional open surgical procedure.

The advantages of minimally-invasive surgery include:

• Safety – the aim is to reduce bleeding and risk of infection from the procedure.
• Less damage – making a smaller incision means less scarring and less harm to the nearby muscles and soft tissue.
• Faster recovery – you’re likely to experience less post-operative pain and may even be able to go home on the day or day after the procedure as there is less muscle damage.

These are relative advantages, so there’s still a level of risk involved. Recovery can take a few weeks and involves light physiotherapy to build up your strength and mobility again.

So which is better?

It really depends on the patient and what kind of spinal problem you have. Minimally-invasive surgery has many advantages, but it is not any more “efficient” than open surgery – it is simply a different technique.

The development of minimally-invasive techniques has been exciting because it gives us more options for our patients. Your surgeon should discuss with you in detail the benefits and risks of the techniques on offer. Don’t be afraid to voice your concerns and ask how the procedure works – it’s important that you make an informed choice, and that you can come to a decision you’re comfortable with.