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18 13. Digital fluoroscopy, image guidance, high resolution endoscopy and minimally invasive surgical tools all play a vital role in conducting minimally invasive spine surgery. In addition, a recent study shows that patients benefit from a 61.6 percent to 83.5 percent radiation reduction when they undergo cannulation and K-wire placement procedures. 14. According to the American Academy of Orthopaedic Surgeons, tubular retractors create passageways for the surgeon to reach problem- atic areas in the lower back while operating microscopes illuminate and magnify the target areas during procedures. 15. Minimally invasive techniques can't treat everything or everyone, according to Cleveland Clinic. Many minimally invasive spine surgeons limit their practice to otherwise health patients under a certain BMI, ASA score and age. 16. Dr. Singh recently founded the Minimally invasive Spine Study Group. MISSG is a multi-institutional organization that promotes re- search and advancement of MISS and houses REDCAP, an online pa- tient registry containing data from 3,000 patients treated with MIS tech- niques. 17. e Society for Minimally Invasive Spine Surgery was formed in 2007. e organization strives to define and advance the field of min- imally invasive spine surgery. Greg Anderson, MD, serves as interna- tional chairperson; William Taylor, MD, is the founder and current ed- ucation chair; Kevin Foley, MD, is the research chair; Larry Khoo, MD, currently serves as marketing chair; Roger Härtl, MD, is centers of excel- lence chair and Frank Phillips, MD, is regional chair (North America). e organization advocates on behalf of education, clinical research and documentation, marketing, MIS centers of excellence and governance as they pertain to the ever-evolving MIS field. 18. MIS is more cost effective than open spine surgery, according to a 2011 study published in SAS Journal, now known as the Internation- al Journal of Spine Surgery. e study showed that minimally invasive transforaminal lumbar interbody fusion was $14,183 on average while open lumbar fusion came out at $18,633. A separate study found total inflation-adjusted acute hospitalization costs averaged at $20,187 for one-level MIS procedures, whereas open surgeries costs averaged out at $29,947. 19. Radiation exposure is a concern for spine surgeons and OR teams. A study published in e Journal of Spinal Disorders and Techniques examined radiation exposure during transforaminal lumbar interbody fusion, comparing MIS and open techniques. e study authors found average fluoroscopy time during the open procedure was 39.42 seconds, compared to 94.21 seconds during MIS procedures. Patients who underwent the MIS procedure were exposed to 2.4-fold more radiation than the open surgery patients. e increased radiation exposure could be tolerable for patients, concluded the study authors, but surgeons performing a high volume of these procedures throughout their career are taking precautions to limit exposure. 20. All spine surgeries performed in ASCs are MIS. Between 1994 and 2006, procedures for intervertebral disc disorders increased 540 percent and spinal stenosis procedures increased 926 percent. During the same time, intervertebral disc disorder cases in ASCs jumped 340 percent. Lumbar disc disease was the most common diagnosis for spine patients during this time period. n 5 Key Notes on MIS vs. Open Technologies for Lumbar Spinal Fusion By Laura Dyrda A new study published in The Spine Journal examines minimally invasive spinal fusion technologies and whether they lead to a better outcome after elective in- terbody fusion. The study authors collected data from the National Neuro- surgery Quality and Outcomes Database examining patients who underwent one- or two-level interbody lumbar fusion for spinal stenosis or grade I spondylolisthesis. The patients either received MIS or open procedures. There were 467 pa- tients who underwent the procedure with MIS technologies and 1,480 who underwent open surgery. The researchers found: 1. The MIS patients were slightly healthier and more likely to have private insurance than those who underwent open procedures. The MIS patients were also less likely to un- dergo two-level procedures. 2. The MIS cohort was associated with less blood loss, more than half a day shorter stay at the hospital and 5 per- cent reduction in post-discharge inpatient rehabilitation when unmatched with the open procedure patients. The MIS patients also reported equivalent 90-day safety mea- sures to the open procedure patients. 3. The MIS patients were still associated with lower blood loss and shorter length of stay after one-level procedures after propensity matching. The MIS patients who under- went two-level procedures reported similar lengths of stay to the open procedure patients. 4. The patient outcomes in 90-day safety measures were similar and the MIS technologies were associated with equivalent return to work than the open procedure technologies. 5. MIS patients were associated with equivalent patient re- ported pain, physical disability and quality of life through the one-year follow up. "While MIS enabling technologies may increase some in-hospital care efficiencies, MIS clinical outcomes are similar to open surgery for patients undergoing one- and two-level interbody lumbar fusions," concluded the study authors. n