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16 20 Things to Know About Minimally Invasive Spine Surgery By Adam Schrag W ith the minimally invasive spine surgery market predicted to grow at a compound annual growth rate of 7.57 percent between 2016 and 2020, there's much to look forward to. Here are 20 things to know about minimally invasive spine surgeries: 1. MIS spine surgery techniques allow surgeons to see and treat injuries or disorders without retracting or damaging nearby muscles, according to the American Association of Neurological Surgeons. 2. Patients oen feel less pain and experience fewer complications during and aer MIS procedures and their hospital stays are typical- ly shorter than patients who undergo open surgery. Kern Singh, MD, co-founder of Chicago-based Minimally Invasive Spine Institute at Rush compared minimally invasive and open spine procedures and concluded that open surgery takes three hours compared to the 75-minute mini- mally invasive procedure. In addition, Dr. Singh found that open spine surgery is associated with between 400 and 500 mL of blood loss while patients who underwent minimally invasive procedures reported 40 to 50 mL of blood loss. 3. Minimally invasive techniques have been successfully applied to the cervical spine, thoracic spine and the lumbar region since the 1990s, when MIS decompression and spinal fusion procedures were first car- ried out successfully, according to an article published in e Journal of Neurosurgery. 4. e market for MIS spine surgery is expected to grow at a CAGR of 7.57 percent between 2016 and 2020, according to Market Reports World. According to a Technavio report, minimally invasive spine sur- gery is growing in popularity. e market was valued at $3 billion in 2015 and the value is expected to hit $4.45 billion by 2020. 5. Surgeons have adopted surgical techniques from a wide variety of medical fields in order to improve MIS procedures and advances in laser, endoscope and image guidance systems have aided MIS progressions. However, a majority of surgeons still perform open procedures; Med- Star Georgetown University estimates around 10 percent to 20 percent of spine surgeries are performed minimally invasively nationwide, but surgeons at the hospital perform 80 percent of their cases with MIS tech- niques. 6. Robotic systems can play a key role in MIS procedures, particularly in the accuracy of screw placement and reproducibility of outcomes for spine procedures. While controlling a robotic system during surgery, surgeons have the benefit of seeing a 3D image on a console, according to Hopkins Medicine. e highly advanced computer soware system allows them to make extremely precise movements. e worldwide spine surgery robotics market is valued at $26 million and expected to reach $2.77 billion by 2022, according to Researchmoz. Robotic guidance can reduce complication rates from the 12.8 percent (freehand) to 4 percent, as shown by a recent study. 7. Endoscopic spine surgery is another technique MIS spine surgeons use. During this type of procedure, the surgeon inserts a thin, flexible tube with a video camera through a small incision or natural opening into the body. e tube is equipped with surgical tools and a camera that displays the live feed for the surgeon on a monitor. e American Medical Association's CPT 2017 Codebook included the first endoscopic spinal surgery. e code covers endoscopic decompres- sion of the spinal cord, nerve root and more. 8. Minimally invasive surgeries such as microscopic lumbar disectomy, outpatient lumbar fusions, outpatient cervical fusion and other small incision operations are ideal for athletes looking to get back to their top playing shape. Many surgeons have performed MIS procedures on pro- fessional athletes: • Charles Rich, MD, has performed minimally invasive spine sur- gery on golfer Tiger Woods • Luis Manuel Tumialan, MD, performed minimally invasive spine surgery on former Olympic swimmer Amy Van Dyken-Rouen • Christopher Yeung, MD, performed spine surgery on MLB pitcher Brett Anderson of the Chicago Cubs • Joseph Maroon, MD, performed spinal fusion on former Green Bay Packers tight end Jermichael Finley • Robert Watkins III, MD, and Robert Watkins IV, MD, performed a single-level anterior cervical fusion on former Indianapolis Colts and Denver Broncos quarterback Peyton Manning's disc herniation 9. According to Newport Beach, Calif.-based Newport Orthopedic In- stitute, the North American Spine Society's SPORT study showed that between 85 percent and 100 percent of professional athletes returned to their pre-surgery abilities aer a minimally invasive lumbar discectomy and a recovery period between 2.8 months and 8.7 months. 10. e MIS spine device market is projected to grow at a CAGR of 9.1 percent between 2016 and 2021, climbing from a $13.89 billion worth to $21.47 billion over the forecast period. 11. Global companies who play major roles in the MIS spine device market are Ireland-based Medtronic; New Brunswick, N.J.-based John- son & Johnson; Kalamazoo, Mich.-based Stryker Corp.; and U.K-based Smith & Nephew. 12. In 2015, Marietta, Ga.-based Amendia acquired Parsippany, N.J.- based Custom Spine, increasing its MIS spine product portfolio. On Feb. 22, 2017, Austin, Texas-based Wenzel Spine acquired Addison, Texas-based OsteoMed's PrimaLOK SP Interspinous System and its PrimaLOK FF Facet Fixation System. Both platforms help treat lumbar spinal disorders and Wenzel Spine intends to integrate them into its de- veloping MIS pipeline. On June 7, 2016, Warsaw, Ind.-based Zimmer Biomet bought France- based LDR, a medical device company with sales of $164.5 million in 2015, according to Bloomberg. e acquisition strengthened Zimmer Biomet's MIS disc replacement and spinal fusion portfolio.