Complications of minimally invasive spinal surgery

George M. Ghobrial, Hsuan Kan Chang, Michael Y. Wang

Research output: Chapter in Book/Report/Conference proceedingChapter


Minimally-invasive spinal surgery has been rapidly growing in popularity with the aim in improving short-term outcomes through the limitation of approach-related morbidity. In this chapter, the authors focus on complication avoidance in minimally-invasive spinal surgery, which begins with careful preoperative selection of all candidates in the clinic. Competency in MIS surgery requires an understanding of specific anatomic corridors utilized in MIS approaches. Several key concepts in complication avoidance are elaborated. Understanding the relevant patient-specific anatomy can avert major neurovascular injury. Uncomplicated access of the lateral disc space can still be complicated by subsidence in the long-run. Iatrogenic endplate injury due to aggressive disc space preparation can be viewed as a procedural complication as subsidence reverses indirect decompression. Tubular approaches have a higher learning curve and carry an increased risk for durotomy and nerve root injury. Careful preoperative consideration should go into the selection of these patients as severely spondylotic or morbidly obese patients can lead to increased operative durations, time spent in the prone position, increased anesthesia, airway edema, and all other associated morbidity. Lastly, the MIS posterior cervical foraminotomy minimizes muscular detachment of paraspinal neck musculature that is key in preserving normal cervical alignment. Utilization of decompression only procedures, even muscle splitting approaches in patients with preoperative cervical kyphosis should be done with careful consideration as there is still an elevated risk for worsening cervical deformity by loss of cervical lordosis and increased cervical sagittal malalignment.

Original languageEnglish (US)
Title of host publicationComplications in Neurosurgery
Number of pages7
ISBN (Electronic)9780323509619
ISBN (Print)9780323510509
StatePublished - Jan 1 2018


  • Complications
  • Lateral lumbar interbody fusion
  • Minimally invasive spinal surgery
  • MIS
  • MIS fusion
  • Posterior cervical foraminotomy
  • Tubular

ASJC Scopus subject areas

  • Medicine(all)


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