This post was written by Dr. Marc Greenberg, and Dr. Micah Smith, spine surgeons with SpineONE, a division of Ortho NorthEast, in partnership with Parkview Health.
In this post, we explain how minimally invasive and endoscopic techniques are changing, what recovery looks like and why having every option available matter for the patients we serve across northeast Indiana and northwest Ohio.
Why the incision isn’t really the point
When patients hear “minimally invasive,” they tend to picture a smaller scar. That’s part of it, but it isn’t the most important part. What matters is what’s happening underneath the skin. In traditional open spine surgery, reaching the spine means stripping muscles off the bone and holding them aside with retractors under tension for significant periods of time. Even when the operation goes perfectly, the muscle, ligament and bone disruption needed to get there is a major reason patients have pain afterwards.
Minimally invasive and endoscopic techniques approach the same problem from a different angle — literally. Instead of cutting through the muscle, we work between the muscle fibers, gently spreading them apart with a series of small dilators. The spinous processes (the small bones you can feel on your back), the ligaments that connect them (known as the posterior tension band) and the surrounding soft tissue are largely left alone. The work done to accomplish the goals of spine surgery are the same. The road to get there is just much kinder to the body.
What is minimally invasive spine surgery?
Minimally invasive spine surgery (often abbreviated MIS) uses a tubular retractor — a small cylinder, typically 16 to 22 mm wide — placed through a small, typically less than 2 cm, incision off the midline. The surgeon operates through this tube using a microscope and specialized instruments. Common procedures performed this way include:
- Microdiscectomy for a herniated disc
- Laminectomy or laminotomy for spinal stenosis
- Transforaminal lumbar interbody fusion (TLIF) for instability or spondylolisthesis
Because the muscles are spread rather than stripped, blood loss is dramatically lower, post-operative pain is reduced and most patients are discharged within 24 hours — sometimes the same day. For procedures that traditionally required a 3- to 5-day hospital stay, this is a meaningful change. Published studies comparing MIS to open have consistently shown lower blood loss, fewer surgical site infections and shorter hospital stays, with comparable long-term pain and functional outcomes.
Just as importantly, MIS allows us to preserve structures that don’t need to be removed in the first place. For lumbar stenosis (a condition where the space in your lower back gets too small and squeezes your nerves) we can decompress both sides of the spinal canal through a single small opening on one side, leaving the spinous process, the interspinous ligaments and the muscle on the opposite side completely untouched.
What is endoscopic spine surgery?
Endoscopic spine surgery takes the same philosophy further. Instead of a tubular retractor, we use a high-definition endoscope — a thin tube with a camera and working channel — inserted through an incision typically less than 1 cm (about 7 to 8 mm). For perspective, that’s smaller than the diameter of a quarter. We are literally able to perform spine surgery now similar to our sports colleagues who do knee and shoulder arthroscopy.
Through that tiny opening, with continuous saline irrigation keeping the field clear and sterile, we can remove herniated disc material, decompress pinched nerves, and address foraminal stenosis under direct, magnified visualization. There is essentially no muscle dissection at all, because the working channel is smaller than the muscle bundles themselves — the fibers simply move aside.
Patients who are good candidates often go home within an hour or two of surgery, with a single small Band-Aid covering the incision. Athletes and patients with physically demanding jobs frequently return to activity in days rather than weeks.
Who is the right fit?
Minimally invasive and endoscopic surgery are not always the right answer. Some conditions genuinely benefit from a traditional open approach, and patient anatomy, symptoms, and overall health all factor into the decision.
However, for the right patient, these techniques are transformative. We tend to consider patients well-suited for MIS or endoscopic surgery when they have:
- A symptomatic single- or two-level lumbar disc herniation that hasn’t responded to conservative care
- Arthritis, known asforaminal or lateral recess stenosis pinching a nerve causing radiating leg pain
- Slipped vertebrae/discs
- Arm pain from a disc herniation
- A medically frail status that makes them poor candidates for prolonged general anesthesia
- An active lifestyle or physical occupation where preserving paraspinal muscle function matters
Patients who are typically better served by other approaches include those with significant spinal deformity, multilevel instability, high-grade spondylolisthesis (when a bone in your spine moves out of place), certain tumors and complex revision cases.
The goal is always to match the procedure to the condition. Not the other way around.
Why a full-spectrum spine team matters
A surgeon who only performs one type of operation will tend to recommend that operation. We think patients are better served by a team that can offer the entire range of spine surgery and pick the best tool for the problem.
When you choose Parkview and Ortho Northeast (ONE), you get world-class expertise in:
- Lateral approaches — including XLIF, OLIF, and prone ALIF
- Motion preservation — cervical and lumbar disc replacement for the right candidates
- Robotic-assisted and navigation-guided spine surgery
- Traditional open techniques for complex deformity, multilevel instability, and challenging revision cases
- Comprehensive non-surgical care, including pain management and physical therapy through our broader Parkview and ONE network
Patients are evaluated by a surgeon whose first question is not “How do I fit this person to my procedure?” but “What does this person’s anatomy and pathology actually call for?” Sometimes that’s an 8-mm endoscopic discectomy. Sometimes it’s a robotic-assisted fusion. Sometimes it’s no surgery at all. We are committed to making sure every patient gets the right answer for them.
When should a patient be evaluated?
We encourage patients and referring providers to consider a spine consultation when any of the following are present:
- Back or neck pain that limits daily activity despite 6 or more weeks of conservative care
- Radiating pain, numbness or weakness in an arm or leg
- Neurogenic claudication — leg pain or heaviness that worsens with walking and improves with sitting or leaning forward
- Any new bowel or bladder dysfunction, saddle anesthesia or progressive weakness (these warrant urgent evaluation
Most back and neck pain improves without surgery, and that is always where we start. But when surgery is needed, the right operation done well, through the smallest incision possible, can give patients their lives back.
If you have questions or would like to refer a patient, the spine specialists at Parkview and Ortho Northeast are here to help. To schedule an appointment, call 260-266-4005 or visit parkview.com/ortho.
