History of minimally invasive spine surgery.

Patients prefer minimally invasive techniques because such techniques reduce recovery times and provide cosmetic benefits. Reviewing the history of minimally invasive surgery helps us understand the advances in spine surgery. Minimally invasive spine surgery has adopted techniques from several fields to better treat spinal disorders. Minimally invasive spine surgery has been influenced by advances in lasers, endoscopy, and image guidance systems. Discogenic disorders have been treated by using chemonucleolysis, automated percutaneous discectomy, and intradiscal thermoablation. Endoscopic techniques have been used to treat spinal disorders. Thoracoscopes and laparoscopes have been used to perform anterior release of scoliotic or kyphotic deformities and to perform transthoracic microsurgical discectomies. The role of spinal thoracoscopy has expanded to include corpectomy, vertebral reconstruction with internal fixation, hardware application, and resection of neurogenic, spinal, and paraspinal tumors. Advances in interbody fusion cage technology have generated a great deal of interest in laparoscopic techniques. Image-guided systems are widely used in intracranial surgery and have been adapted to facilitate screw placement since the middle 1990s. The use of image-guided systems for pedicle screw placement has improved placement accuracy. The system relies on precise localization of the pedicles with computed tomography. Minimally invasive surgery is designed for "conventional" operations involving extensive anatomic dissections performed via small incisions; it yields shorter recovery times and less morbidity.