title: "Minimally invasive" lumbar spine surgery: a critical review.
abstract: BACKGROUND
  Minimal-access technology has evolved rapidly with "tubular" or "percutaneous" approaches for decompression and stabilization in the lumbar spine. Potential benefits (smaller scars, diminished local pain, reduced blood loss, reduced postoperative wound pain, shorter hospital stays) have to be weighed against possible drawbacks (reduced orientation, steep learning curve, increased radiation exposure, dependency on technology, cost). While non-comparative case series are often rather enthusiastic, comparative studies and particularly RCTs are scarce and might convey a more realistic appreciation.
  
  
  METHODS
  A MEDLINE search via PubMed was performed to find all English-language studies comparing "open" or "traditional" or "conventional" with "minimally invasive" or "percutaneous" or "tubular" approaches in degenerative lumbar spine surgery.
  
  
  RESULTS
  Only nine comparative studies could be retrieved altogether. No clear benefit could be found for minimally invasive procedures in lumbar disc herniation, TLIF, or PLIF. There seems to be a slight advantage in terms of hardware safety in open procedures.
  
  
  CONCLUSIONS
  This review, based solely on the very limited number of available comparative studies, shows no relevant benefit from minimally invasive techniques, and a tendency for more safety in open procedures in lumbar disc herniation, TLIF and PLIF.
authors.affiliation: Department of Neurosurgery, Klinik Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland. mpayer@hotmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Payer
mesh_terms: D017587:Diskectomy, Percutaneous / Q000009:adverse effects / Q000639:trends*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000601:surgery*; D007796:Laminectomy / Q000009:adverse effects / Q000639:trends; D008159:Lumbar Vertebrae / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000639:trends*; D055009:Spondylosis / Q000473:pathology / Q000601:surgery*