Current Trends in Minimally Invasive Spinal Surgery

The past 30 years has seen a dramatic expansion in the technologies available to practitioners of interventional pain management for the spine. This survey article spans the historical development from spinal decompression and fixation techniques to the most recent endoscopic and laser based therapies. This review is based on the six basic mechanisms for reducing pain of spinal origin: 1) anti-inflammatory/analgesic; 2) lysis of scar/de-tethering; 3) decompression; 4) arthrodesis/fixation; 5) neural ablation; and 6) neuromodulation. Multiple therapeutic modalities are summarized in each of these domains including; intradiscal electrothermy, epiduroscopy with laser ablation, percutaneous or endoscopic instrumentation and arthrodesis, vertebral augmentation, interspinous process decompression, percutaneous removal of the ligamentum flavum, intrathecal medication infusion, and spinal cord or peripheral nerve, neuromodulation. Intracranial pain techniques are beyond the scope of this article. Each technique is addressed from the standpoints of basic concepts and anatomy, as well as efficacy and complications.