The Truth About Minimally Invasive Spine Surgery: What It Can and Cannot Do

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University

“Minimally invasive” is one of the most marketed terms in spine surgery, and also one of the most misunderstood. Patients often arrive believing it means a fundamentally different, lower-risk operation. The reality is more specific, and more useful to understand before deciding on a surgical approach.

What “minimally invasive” actually means

Minimally invasive spine surgery (MIS) refers to techniques that accomplish the same surgical goal — decompressing a nerve, stabilizing a segment, removing a herniated disc — through smaller incisions and with less disruption to the surrounding muscle than traditional open approaches. It is a description of surgical technique, not a separate category of operation with different goals.

What MIS genuinely does well

• Less muscle disruption — tubular retractors and smaller incisions preserve more of the surrounding muscle compared to traditional open dissection
• Less blood loss — consistently demonstrated in the literature for procedures like microdiscectomy and MIS-TLIF
• Faster early recovery — less post-operative pain and earlier mobilization in the first days to weeks, for appropriate procedures
• Outpatient or short-stay surgery — many MIS procedures, such as microdiscectomy, can be performed on an outpatient basis

What MIS does not do

• It does not change the long-term fusion timeline. Whether a fusion is performed through a small incision or a large one, the bone still takes the same biological time — typically months — to heal solidly.
• It is not appropriate for every condition. Severe spinal deformity, multilevel complex reconstruction, and many revision surgeries require open exposure to safely achieve the necessary correction. Choosing a minimally invasive approach where it isn’t suited can compromise the result.
• It does not eliminate surgical risk. The risks of anesthesia, infection, and nerve injury are present in any spine procedure, regardless of incision size.
• Smaller incision does not mean simpler surgery. Some of the most technically demanding procedures in spine surgery — robotic-assisted multilevel fusion, for example — are performed through small incisions but require significant surgical skill and judgment.

How the decision should actually be made

The right approach — open, minimally invasive, or a combination — should be determined by your specific anatomy, the severity and pattern of your condition, and the surgical goal, not by a general preference for one approach over another. Dr. Sardar uses minimally invasive techniques, including robotic-assisted navigation, whenever they are the right tool for the job, and uses open techniques when the complexity of the case requires it. The goal is always the safest and most effective path to the result you need, not the smallest possible incision.

This article is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition.

To schedule a consultation with Dr. Sardar, call 212-932-5187 or visit the contact page.