Impact of Minimally Invasive Spine Surgery Training on Surgeon Practice and Outlooks

Introduction: Minimally invasive spine surgery (MISS) has become more prevalent as efforts are made to improve patient recovery and outcomes. However, there has been discrepancies in literature over whether MISS leads to better outcomes than open surgeries. This project aims to expand on previous studies and clarify the relationship between MISS training type, length, usage in practice, and the outlooks surgeons have on MISS compared to open surgeries.

Methods: An online survey was sent through social media and emailed to AANS members who listed “Spine” as a subspecialty. Eligible surgeons were asked to answer a variety of questions regarding MISS training, usage, and outlook. Survey questions focused on MISS procedures performed in the lumbosacral (L1-S1) region. Responses were stratified by whether they had MISS training during residency, whether they did a fellowship, and how long they have practiced MISS. Comparative analysis was performed with these groups to compare their effects on MISS usage and outlooks. Additional analysis compared MISS usage rates with their outlooks.

Results: A total of 106 surgeons completed the survey. MISS training during residency did not impact MISS practice length (p = 0.067) or usage rate (p = 0.675). MISS fellowship increased surgeons who practiced MISS for a shorter period of time while decreased those who practiced longer (p = 0.003). Fellowship training also improved surgeon perceptions on MISS discectomy complication rates (p = 0.008). Surgeons who practiced longer viewed procedural time for MISS in general (p = 0.003) and fusions (p = 0.004) as shorter, and less complication rates for fusions (p = 0.025). Regardless of the stratifications, surgeons rated patient outcomes as better compared to open surgeries.

Conclusion : The type of MISS training, specifically fellowships, was seen to influence its overall practice length afterwards. While certain procedural times and complications rates were perceived as better in MISS compared to open surgeries depending on training and practice length, outlooks on patient outcomes remained positive among surgeons regardless of background. Further studies to analyze these differences will better establish the state of training in MISS and enhance its application for future education in spine surgery and patient care.