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New Concepts in Minimally Invasive Spine Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 25 April 2026 | Viewed by 526

Special Issue Editors

Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Interests: spinal cord injury; low back pain; disc degeneration; minimally invasive spine surgery; spinal deformity; traumatic brain injury
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Guest Editor
Department of Neurosurgery, University of Miami Hospital, Miami, FL, USA
Interests: minimally invasive spine surgery; awake spine surgery; ERAS (enhanced recovery after surgery); endoscopic spine surgery; spinal deformity; robotics; spinal cord injury biomarkers
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The field of spine surgery has undergone profound advancements over the past several decades, significantly enhancing both the precision and efficacy of surgical interventions. Among these developments, the emergence of minimally invasive spine surgery (MISS) represents a paradigm shift, enabling surgeons to address complex spinal pathologies while minimizing disruption to surrounding tissues. As our understanding of spinal biomechanics and pathology has deepened, so too has our ability to refine surgical techniques that balance efficacy with reduced procedural morbidity.

A confluence of technological innovations—including the surgical microscope, specialized instrumentation, image-guided navigation, tubular retractors, expandable cages, lateral approaches, virtual and augmented reality integration, robotic assistance, and endoscopic systems—has markedly expanded the armamentarium available to spine surgeons. These advancements have facilitated the more precise decompression of neural structures, improved spinal stabilization, and enhanced the correction of spinal deformities, ultimately contributing to safer and more effective patient outcomes.

Nevertheless, despite these advancements, critical challenges persist. One fundamental issue is the lack of consensus on the precise definition of "minimally invasive spine surgery". In certain instances, an overzealous pursuit of minimizing incision size or avoiding necessary tissue dissections may lead to missed pathology, unintended blind tissue damage, or inadequate surgical intervention. Thus, optimizing treatment strategies requires not only proficiency in emerging technologies but also a nuanced understanding of when and how to deploy them effectively.

This volume explores contemporary advancements and evolving paradigms in minimally invasive spine surgery, with a focus on integrating novel techniques into clinical practice. By critically examining the principles and applications of minimally invasive spine surgery, this work aims to equip spine surgeons with the knowledge necessary to refine their surgical approach, optimize patient outcomes, and advance the field in an era of rapid technological evolution.

Dr. Yi Lu
Prof. Dr. Michael Y. Wang
Guest Editors

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Keywords

  • minimally invasive spine surgery
  • image navigation
  • tubular retractor
  • endoscopic spine surgery
  • virtual and aug-mented reality
  • lateral spine surgery

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Published Papers (1 paper)

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16 pages, 760 KB  
Systematic Review
Reconsidering Anesthesia in Lumbar Surgery: An Umbrella Review of Awake Versus General Anesthesia
by Favour C. Ononogbu-Uche, Carl Tchoumi, Nolan M. Stubbs, Arnav Sharma, Raymond J. Gardocki, Alok Sharan, Muhammad M. Abd-El-Barr, Ernest E. Braxton and Awake Spine Research Group
J. Clin. Med. 2025, 14(23), 8335; https://doi.org/10.3390/jcm14238335 - 24 Nov 2025
Viewed by 311
Abstract
Background/Objectives: Lumbar degenerative disease drives numerous elective spine surgeries, and anesthetic choice significantly influences airway risk, hemodynamics, analgesia, mobilization, and recovery. Interest in awake lumbar surgery, typically using spinal anesthesia (SA) with light sedation, has grown as comparative studies suggest comparable safety [...] Read more.
Background/Objectives: Lumbar degenerative disease drives numerous elective spine surgeries, and anesthetic choice significantly influences airway risk, hemodynamics, analgesia, mobilization, and recovery. Interest in awake lumbar surgery, typically using spinal anesthesia (SA) with light sedation, has grown as comparative studies suggest comparable safety to general anesthesia (GA) with potential reductions in opioid use, nausea, time to ambulation, and efficiency metrics. However, these benefits may be context-dependent under standardized perioperative care. Therefore, the aim of this umbrella review is to synthesize previously published meta-analyses that compare postoperative outcomes between SA and GA in patients undergoing lumbar spine surgery. Methods: A systematic literature search was executed with defined criteria across PubMed, Embase, and Web of Science. Data analysis was performed using the metaumbrella R package to report equivalent Hedges’ g values. Each meta-analysis was evaluated with the AMSTAR2 tool, and the credibility of the evidence was determined with Ioannidis criteria. Results: Seven meta-analyses were included. Pooled data showed that SA was associated with shorter operative time, reduced length of stay, and lower intraoperative blood loss, supported by class III credibility for operative time and length of stay and class IV for blood loss in the setting of high between study heterogeneity. SA was also associated with lower odds of postoperative nausea and vomiting and reduced postoperative analgesic requirements, both graded as class IV with prediction intervals that encompassed the null. Intraoperative hypotension and bradycardia did not differ significantly between SA and GA, and postoperative pain scores and overall complication rates were similarly neutral. Conclusions: This umbrella review identifies potential advantages of SA in lumbar spine surgery, including shorter operative time, reduced length of stay, lower intraoperative blood loss, and lower postoperative nausea and analgesic requirements, while finding no consistent differences in hemodynamic events or overall complications. These findings suggest SA as an alternative pathway to general anesthesia for selected lumbar procedures but highlight substantial heterogeneity and low-to-intermediate credibility for several endpoints, underscoring the need for additional high-quality, protocolized comparative studies to refine effect sizes and define optimal patient and procedural selection. Full article
(This article belongs to the Special Issue New Concepts in Minimally Invasive Spine Surgery)
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