Spine Health Special Section
Evolution of Minimally Invasive Lumbar Spine Surgery
Arbaz A. Momin1 and Michael P. Steinmetz2
Spine surgery has evolved over centuries from first being
practiced with Hippocratic boards and ladders to now being
able to treat spinal pathologies with minimal tissue invasion.
With the advent of new imaging and surgical technologies,
spine surgeries can now be performed minimally invasively
with smaller incisions, less blood loss, quicker return to daily
activities, and increased visualization. Modern minimally
invasive procedures include percutaneous pedicle screw
fixation techniques and minimally invasive lateral approach
for lumbar interbody fusion (i.e., minimally invasive trans-
foraminal lumbar interbody fusion, extreme lateral interbody
fusion, oblique lateral interbody fusion) and midline lumbar
fusion with cortical bone trajectory screws. Just as evolu-
tions in surgical techniques have helped revolutionize the
field of spine surgery, imaging technologies have also
contributed significantly. The advent of computer image
guidance has allowed spine surgeons to advance their ability
to refine surgical techniques, increase the accuracy of spinal
hardware placement, and reduce radiation exposure to the
operating room staff. As the field of spine surgery looks to the
future, many novel technologies are on the horizon, including
robotic spine surgery, artificial intelligence, and machine
learning to help improve preoperative planning, improve
surgical execution, and optimize patient selection to ensure
improved postoperative outcomes and patient satisfaction. As
more spine surgeons begin incorporating these novel mini-
mally invasive techniques into practice, the field of minimally
invasive spine surgery will continue to innovate and evolve
over the coming years.
Key words
- Image guidance
- Minimally invasive spine surgery
- MIS TLIF
- OLIF
- XLIF
Abbreviations and Acronyms
CT: Computed tomography
MED: Microendoscopic diskectomy
MIS: Minimally invasive spine
MIS TLIF: Minimally invasive transforaminal lumbar interbody fusion
OLIF: Oblique lateral interbody fusion
TLIF: Transforaminal lumbar interbody fusion
622 www.SCIENCEDIRECT.com
INTRODUCTION
T he foundations of today’s modern technologic innovations
in spine surgery can be traced back to teachings and
principles of Egyptian and Greek scholars. In Greece,
Hippocrates (c. 460e370 BCE) was lauded for his teachings of the
spine, which stressed the importance and function of the spine.
His practices focused on spine fractures, deformities, and back
pain. In fact, Hippocrates may have been the first person to
discuss back pain and sciatica.1 Hippocrates developed his own
methods to treat spinal pathologies. To correct spine curvatures,
he created a device known as the Hippocratic ladder. This
device was used to correct spinal curvature by shaking the
patient while they were tied on a ladder upside down (Figure 1).
He was also famous for his other device, called the Hippocratic
board. This device was used to forcibly reduce humps or
abnormal curvatures in the spine. The Hippocratic board
required the patient to be tied to a plank while traction was
applied and the physician would use their hands, feet, or even
their whole body to press the spinal hump (Figure 2). Centuries
later, the development of new imaging technologies and surgical
instrumentations launched a surgical revolution that could help
treat spinal pathologies with minimal tissue invasion.
The first account of a lumbar laminectomy in the United States
was performed in 1829.2 In 1934, Mixter and Barr3 published their
seminal work on the correlation between disk herniation and
sciatica. They proposed that the optimal surgical management
of disk herniation was a diskectomy via a laminectomy. This
required extensive removal of lamina and disk material via an
intradural approach. This remained the criterion standard
treatment for disk herniation for several decades.
Although these techniques were popular and well accepted by
the spine surgery community, these approaches required extensive
tissue dissection, profound blood loss, and high risk of developing
morbidities. In the mid-1960s, Yasargil developed the operative
From the 1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University,
Education Institute, Cleveland Clinic, Cleveland, Ohio; and 2Center for Spine Health,
Department of Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, Cleveland,
Ohio, USA
To whom correspondence should be addressed: Michael P. Steinmetz, M.D.
[E-mail: STEINMM@ccf.org]
Citation: World Neurosurg. (2020) 140:622-626.
https://doi.org/10.1016/j.wneu.2020.05.071
Journal homepage: www.journals.elsevier.com/world-neurosurgery
Available online: www.sciencedirect.com
1878-8750/$ - see front matter ª 2020 Published by Elsevier Inc.
WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2020.05.071

ARBAZ A. MOMIN AND MICHAEL P. STEINMETZ
Figure 1. The Hippocratic ladder was used in ancient Greece to correct
spinal curvature by shaking the patient while they were tied on a ladder
upside down. (Permission has been granted by Elsevier to republish this
image published in Samartzis D, Shen FH, Perez-Cruet MJ, Anderson DG.
Minimally invasive spine surgery: a historical perspective. Orthop Clin
North Am. 2007;38:305-326.)
microscope and microsurgical techniques for cranial surgery.4,5
These instruments and techniques were later incorporated into
spine surgery to help reduce the high rates of surgical
morbidity. The application of Yasrgil’s operative microscope led
to a revolution in spine surgery. Spine surgery could now be
performed with a smaller incision, less blood loss, quicker
return to daily activities, and increased visualization.
The evolution of minimally invasive spine (MIS) surgery for
decompression of the neural structures began with the application of
uniportal procedures, using an arthroscope for decompression of
contained disk herniation. The first laparoscopic lumbar diskectomy
was reported by Obenheim in 1991.6 The efficacy of different
endoscopic surgical procedures has been documented, which has
led to the development of more complex and biportal arthroscopic
procedures for treatment of noncontained herniations. In 1997,
Foley and Smith7 introduced a new surgical technique called
microendoscopic diskectomy (MED), which allowed for lumbar
nerve root decompression using an endoscopic minimally invasive
approach. This technique originally consisted of using an operative
endoscope with the tubular system; however, the tubular retractors
were later modified to include a microscope. In 1999, the second-
generation MED system called the METRx (Medtronic Sofamor
Inc., Memphis, Tennessee, USA) was developed. The utilization of
tubular retractors allowed for less muscle dissection, better cosmetic
WORLD NEUROSURGERY 140: 622-626, AUGUST 2020
SPINE HEALTH SPECIAL SECTION
EVOLUTION OF LUMBAR MIS SURGERY
Figure 2. The Hippocratic board used to reduce humps or abnormal
curvatures in the spine by force exerted from the physician. (Permission
has been granted by Elsevier to republish this image published in
Samartzis D, Shen FH, Perez-Cruet MJ, Anderson DG. Minimally invasive
spine surgery: a historical perspective. Orthop Clin North Am.
2007;38:305-326.)
incisions, decreased pain, increased operative time, and faster re-
covery after surgery.8-12 The MED technique has been used to manage
posterolateral lumbar disk herniation from L2-S1 and far-lateral
lumbar disk herniation. Some limitations of the METRx system
include increased cost, steeper learning curve, and a potential
increased risk for nerve root injury because of limited exposure.13
The use of minimally invasive surgery for fusion of the spine
was introduced at a later date.14 Magerl,15 however, introduced
this technique for percutaneous external transpedicular fixation
of the lumbar spine in the 1980s. Percutaneous dorsolateral
interbody fusion was also later performed successfully by Leu
et al.,16 who reported on the procedure in 1993. Drawbacks of
these procedures included the likelihood of screw tract
infection, suboptimally prepared fusion, and discomfort
associated with externally placed implants.
Full percutaneous endoscopic spine surgery has continued to
evolve over the past several years and is now a standard surgical
technique. Compared with traditional open laminectomies,
studies on minimally invasive endoscopic lumbar laminectomy
have shown a reduction in postoperative chronic back pain, a
reduction in iatrogenic injury, and faster recovery time.17-19 Today,
endoscopic spine surgery can be used to treat a wide variety of
pathologies including disk herniation, foraminal stenosis, and
canal stenosis. The main advantages of endoscopic spine surgery
www.journals.elsevier.com/world-neurosurgery 623

ARBAZ A. MOMIN AND MICHAEL P. STEINMETZ
are its lower morbidity, attributable to the minimally invasive
approach, and cosmetic advantages. Significantly, patients
experience less postoperative pain because of the avoidance of
extensive muscular dissection. The most significant disadvantage
of endoscopic stabilization is that it is time consuming. This
aspect can be overcome, but there is a considerable learning curve.
The technology and equipment costs for this approach also create
a large upfront investment requirement.
Subsequent advances in the evolution of minimally invasive
surgery for fusion and stabilization included percutaneous
interbody fusion during arthroscopic disk surgery, transperitoneal
and thoracoscopically assisted placement of interbody cage
implants, and percutaneous translaminar facet screw placement.
These techniques were eventually supplanted by modern mini-
mally invasive procedures such as percutaneous pedicle screw
fixation, minimally invasive lateral approach for lumbar interbody
fusion (i.e., minimally invasive transforaminal lumbar interbody
fusion [MIS TLIF], extreme lateral interbody fusion, oblique lateral
interbody fusion [OLIF]), and midline lumbar fusion with cortical
bone trajectory screws.
In modern MIS surgery, transforaminal lumbar interbody fusion
(TLIF) has become a mainstay of treatment for conditions that
require fusion/fixation in the lumbar spine. The MIS TLIF was first
introduced in 2003 by Foley et al.,20 and since then, numerous
studies have shown equivalent or better clinical outcomes for
MIS TLIF compared with traditional open TLIF.21-24 This mini-
mally invasive approach has been shown to result in decreased
tissue injury, less blood loss, decreased postoperative pain,
shorter hospital stay, and faster recovery. There are some potential
complications from MIS TLIF operations, which are shared with
those from traditional TLIF operations. They include, but are not
necessarily limited to, allograft malposition, pedicle screw
malposition, infection, cerebrospinal fluid leak, hematoma for-
mation, and postoperative anemia.25,26 MIS surgeons are familiar
with the challenging learning curve associated with the MIS
techniques, and early in one’s career, complications related to
this learning curve are more common. These mistakes are often
related to instrumentation, sometimes resulting in neurologic
deficit. Visualization through the tubular dilator can be limited
and can result in inadequate decompression or neural injury
during graft placement. In one meta-analysis, nearly 1 in 5 of
the reported complications from MIS TLIF were neurologic com-
plications.25 Radiation exposure is another area that is of interest
to MIS surgeons performing this technique. Significant amounts
of radiation can be encountered during these operations when
fluoroscopy is used and performed without the assistance of
image guidance software.
Ozgur et al.27 described the extreme lateral interbody fusion
technique (XLIF [NuVasive, Inc., San Diego, California, USA]) in
2006, which could be used to access the lateral aspect of the
lumbar spine without entering the peritoneal space. This
eliminated the need for an access surgeon, and a large
interbody graft could be used. The approach was also used for
far lateral disk herniations28 and was later expanded to place
interbody grafts at multiple levels, therefore allowing for
significant correction of coronal deformities in scoliosis
surgery.15,29-33 This lateral, transpsoas, retroperitoneal approach
has since become commonplace in the world of MIS surgery.
624 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2020.05.071
SPINE HEALTH SPECIAL SECTION
EVOLUTION OF LUMBAR MIS SURGERY
The OLIF procedure accesses the anterolateral surface of the
disk space and remains anterior to the psoas.34,35 The advantages
of minimally invasive OLIF include the lack of neuromonitoring
because of the prepsoas approach, the decreased incidence of
abdominal wall pain, the easier development of a window to
access multiple levels, and an incision for OLIF that spares the
proximal nervous trunk that innervates the abdominal muscles.
By sparing the proximal nervous trunk, the OLIF procedure
decreases the risk of abdominal wall atony and/or herniation.
The main disadvantages of this technique are the increased risk
of injury to venous structures that lie anterior to the psoas and
transient weakness with hip flexion because of prolonged psoas
retraction.34
Midline lumbar fusion with cortical bone trajectory screws was
described in 2009 by Santoni et al.36 as a novel fusion technique in
which the screw insertion followed a different trajectory than the
conventional path. Traditional pedicle screw fixation requires
extensive tissue dissection to expose the entry points to allow
for lateral to medial screw trajectory insertion. To address this
issue of extensive tissue dissection, less invasive percutaneous
screw placement techniques have been developed in recent
years. However, the standard lateral to medial trajectory of the
screw still relies on the integrity of the trabecular bone at the
pedicle and vertebral body, which could lead to screw loosening
in osteoporotic bone. In cortical bone trajectory, screw fixation
within the pedicle is targeted in a mediolateral path in the axial
plane and a caudocranial path in the sagittal plane. This screw
trajectory engages the cortical bone and theoretically provides
increased cortical bone contact, provides increased screw grip,
and decreases the reliance on trabecular bone.37
Because the percutaneous pedicle screw approach requires an
additional technique for decompression and graft insertion,
Minzuno et al.37 adopted a midline lumbar fusion technique and
combined it with cortical bone trajectory screw fixation. The
drawbacks of this approach include the following: risk of
radiation exposure from fluoroscopy, unfamiliarity among spine
surgeons, and incorrect screw insertion leading to bone
fractures or nerve root injury. The advantage of this technique is
that the cortical bone trajectory causes the screw to maximize its
contact area with high density bone, which provides more rigid
fixation for patients with osteoporosis. The posterior midline
approach decreases the amount of tissue dissection and muscle
damage. Compared with percutaneous pedicle screw fixation
which requires an additional approach for decompression and
fusion, the minimally invasive midline lumbar interbody fusion
can accomplish decompression and fusion within the same sur-
gical field.37
Proper surgical approach has always been a key issue in spine
surgery because of the complex 3-dimensional anatomy of the
spine and incomplete visibility during spinal procedures. These
surgical approaches continue to be refined and evolve over time
with the advent of newer technologies to increase surgical
accuracy. The advent of computer image guidance has allowed
spine surgeons to advance their ability to refine surgical
techniques, increase the accuracy of spinal hardware placement,
and reduce radiation exposure to the operating room staff. Early
methods to assess pedicle screw placement included intra-
operative lateral radiographs for image guidance. This technique
 SPINE HEALTH SPECIAL SECTION
ARBAZ A. MOMIN AND MICHAEL P. STEINMETZ EVOLUTION OF LUMBAR MIS SURGERY

fell out of favor because of poor accuracy of radiographs in
diagnosing pedicle screw malposition.38 Fluoroscopy was later
introduced into spine surgery as an image guidance tool. By
2013, it was estimated that 78% of spine surgeons were using
fluoroscopic navigation as a primary method of image
guidance.39 With this technology, a computer-generated model
of the surgical level is constructed from multiple 2-dimensional
intraoperative fluoroscopic images. Fluoroscopic navigation has
been shown to improve accuracy of pedicle screw placement
compared with conventional fluoroscopy.40
The latest advancement in image guidance systems includes
intraoperative computed tomography (CT) scanebased naviga-
tion. This technology significantly reduces radiation exposure to
operating room staff, allows for imaging of patients in the
operative position, eliminates the extensive time required for the
registration process, and allows for repeated CT imaging if the
patient is moved significantly during surgery. Intraoperative CT
scanebased navigation has been shown to increase pedicle screw
placement accuracy when compared with other image guidance
systems.40-42 In MIS surgery, limited exposure of bony landmarks
prevents the use of paired-point matching registration that is
required for preoperative CT scanebased stereotactic navigation.
This led to the advent of intraoperative CT scan with
3-dimensional stereotaxis. Bourgeois et al.43 used intraoperative
CT scanebased 3-dimensional navigation to percutaneously
place 2132 lumbosacral pedicle screws and reported a breach rate
of 0.33% during MIS surgery. This was compared with a cohort of
4248 pedicle screws placed using fluoroscopy navigation; the
breach rate was 13.1%.44 Bourgeois et al.43 concluded a number
needed to treat of 6 patients with intraoperative CT navigational
guidance to prevent 1 pedicle breach.
To conclude, the advancements in minimally invasive
techniques has opened a new era in spine surgery. The field of
spine surgery began with Hippocrates, the father of spine surgery,
creating ladders and planks to treat spinal pathologies. The field
of spine surgery has evolved from using ladders and planks to now
being able to access the spine through incisions that are w1 to 5
cm. Technologic innovations in imaging and surgical instrumen-
tation has led to these remarkable revolutions seen in spine sur-
gery. Incorporation of these novel minimally invasive techniques
into practice has increasingly grown among surgeons with time.
Spine surgeons and patients are willing to embrace these new
techniques because they decrease tissue dissection, operation
times, complications, blood loss, length of hospitalization, and
incision size. Minimally invasive techniques also improve post-
operative outcomes, decrease health care costs, and allow patients
to return to daily activities earlier than traditional, open
techniques.
As the field of spine surgery looks to the future, many novel
technologies are on the horizon, including robotic spine surgery.
Robotic spine surgery is predicted to be the latest technology that
will revolutionize spine surgery for years to come. Within the past
decade, robotic surgical systems have been widely adopted by
various surgical specialties (i.e., cardiac surgery, urology, general
surgery) to replace the traditional open or laparoscopic proced-
ures. Robotic technology within spine surgery is still being
investigated and has not yet achieved widespread adoption. Initial
studies using robotic assistance to place pedicle screws have
shown promising results45-48; however, as with any new skill,
robotic surgery has a relatively steep learning curve.49
Nonetheless, the integration of robotic technologies into spine
surgery may continue to advance MIS surgery in a safe, efficient,
and predictable way.
In minimally invasive and robotic spine surgery, proper patient
selection is essential to ensure optimal outcomes. In the future,
the incorporation of artificial intelligence and machine learning
will help spine surgeons improve preoperative planning, improve
surgical execution, and optimally select patients to ensure
improved postoperative outcomes and patient satisfaction.
Additionally, artificial intelligence technologies may have the
potential to combine with minimally invasive robotic technologies
to assist spine surgeons in more accurate placement of spinal
instrumentation. Without question, the field of MIS surgery will
continue to innovate and evolve over the coming years.
CRediT AUTHORSHIP CONTRIBUTION STATEMENT
Arbaz A. Momin: Writing - original draft, Writing - review &
editing. Michael P. Steinmetz: Writing - original draft, Writing -
review & editing.

REFERENCES
1. Marketos SG, Skiadas P. Hippocrates: father of
spine surgery. Spine. 1999;24:1381-1387.
2. Keller T, Holland MC. Some notable American
spine surgeons of the 19th century. Spine (Phila Pa
1976). 1997;22:1413-1417.
3. Mixter WJ, Barr JS. Rupture of the intervertebral
disc with involvement of the spinal canal. N Engl J
Med. 1934;211:210-215.
4. Imhof HG, von Ammon K, Yasargil MG. Use of
the microscope in surgery of the lumbar disk
hernia. Aktuelle Probl Chir Orthop. 1994;44:15-20.
10. Kotil K, Tunckale T, Tatar Z, Koldas M, Kural A,
5. Yasargil MG, Krayenbuhl H. The use of binocular
microscope in neurosurgery. Bibl Opthalmol. 1970;
81:62-65.
6. Obenheim TG. Laparoscopic lumbar discectomy:
case report. J Laparoendosc Surg. 1991;1:145-149.
7. Foley KT, Smith MM. Microendoscopic
discectomy. Tech Neurosurg. 1997;3:301-307.
8. Schick U, Dohnert J, Richter A, Konig A,
Vitzthum HE. Microendoscopic lumbar dis-
cectomy versus open surgery: an intraoperative
EMG study. Eur Spine J. 2002;11:20-26.
9. Shin DA, Kim KN, Shin HC, Yoon H. The efficacy
of microendoscopic discectomy in reducing
iatrogenic muscle injury. J Neurosurg Spine. 2008;8:
39-43.
Bilge T. Serum creatine phosphokinase activity
and histological changes in the multifidus muscle:
a prospective randomized controlled comparative
study of discectomy with or without retraction.
J Neurosurg Spine. 2007;6:121-125.
11. Harrington JF, French P. Open versus minimally
invasive lumbar microdiscectomy: comparison of
operative times, length of hospital stay, narcotic
use and complications. Minim Invasive Neurosurg.
2008;51:30-35.
12. Yeung AT, Yeung CA. Minimally invasive
techniques for the management of lumbar disc
herniation. Orthop Clin North Am. 2007;38:363-372.
13. Smith N, Masters J, Jensen C, Khan A,
Sprowson A. Systematic review of micro-
endoscopic discectomy for lumbar disc herniation.
Eur Spine J. 2013;22:2458-2465.
14. Onen MR, Naderi S. History of minimally invasive
spine surgery. World Spine Column J. 2014;5:53-57.

WORLD NEUROSURGERY 140: 622-626, AUGUST 2020 www.journals.elsevier.com/world-neurosurgery 625


ARBAZ A. MOMIN AND MICHAEL P. STEINMETZ
15. Magerl FP. Stabilization of the lower thoracic and
lumbar spine with external skeletal fixation. Clin
Orthop Relat Res. 1984;189:125-141.
16. Leu H, Hauser R, Schreiber A. Percutaneous
lumbar spine fusion. Acta Orthop Scand Suppl. 1993;
251:116-119.
17. Phan K, Mobbs RJ. Minimally invasive versus open
laminectomy for lumbar stenosis. Spine (Phila Pa
1976). 2016;41:91-100.
18. Bresnahan LE, Smith JS, Ogden AT, et al.
Assessment of paraspinal muscle cross-sectional
area after lumbar decompression minimally
invasive versus open approaches. Clin Spine Surg.
2017;30:162-168.
19. Storzer B, Schnake KJ. Microscopic bilateral
decompression by unilateral approach in spinal
stenosis. Eur Spine J. 2016;25:270-271.
20. Foley K, Holly L, Schwender J, et al. Minimally
invasive lumbar fusion. Spine (Phila Pa 1976). 2003;
28(15S):S26-S35.
21. Park P, Wang M, Lafage V, et al. Comparison of
two minimally invasive surgery strategies to treat
adult spinal deformity. J Neurosurg Spine. 2015;22:
374-380.
22. Dhall SS, Wang MY, Mummaneni PV. Clinical and
radiographic comparison of mini-open trans-
foraminal lumbar interbody fusion with open
transforaminal lumbar interbody fusion in 42
patients with long-term follow-up. J Neurosurg
Spine. 2008;9:560-565.
23. Isaacs RE, Podichety VK, Santiago P, et al.
Minimally invasive microendoscopy-assisted
transforaminal lumbar interbody fusion with
instrumentation. J Neurosurg Spine. 2005;3:98-105.
24. Lee KH, Yue WM, Yeo W, et al. Clinical and
radiological outcomes of open versus minimally
invasive transforaminal lumbar interbody fusion.
Eur Spine J. 2012;21:2265-2270.
25. Habib A, Smith ZA, Lawton CD, Fessler RG.
Minimally invasive transforaminal lumbar
interbody fusion: a perspective on current
evidence and clinical knowledge. Minim Invasive
Surg. 2012;2012:657342.
26. Villavicencio AT, Burneikiene S, Roeca CM, et al.
Minimally invasive versus open transforaminal
lumbar interbody fusion. Surg Neurol Int. 2010;1:12.
27. Ozgur B, Aryan H, Pimenta L, Taylor W. Extreme
Lateral Interbody Fusion (XLIF): A Novel Surgical
Technique for Anterior Lumbar Interbody Fusion.
Spine J. 2006;6:435-443.
28. Ahn Y, Lee SH, Park WM, Lee HY. Posterolateral
percutaneous endoscopic lumbar foraminotomy
626 www.SCIENCEDIRECT.com
for L5-S1 foraminal or lateral exit zone stenosis.
Technical note. J Neurosurg. 2003;99(suppl 3):
320-323.
29. Knight M, Goswami A. Management of isthmic
spondylolisthesis with posterolateral endoscopic
foraminal decompression. Spine (Phila Pa 1976).
2003;28:573-578.
30. Knight MT, Goswami A, Patko JT, Buxton N.
Endoscopic foraminoplasty: a prospective study
on 250 consecutive patients with independent
evaluation. J Clin Laser Med Surg. 2001;19:73-81.
31. Jang JS, An SH, Lee SH. Transforaminal percuta-
neous endoscopic discectomy in the treatment of
foraminal and extraforaminal lumbar disc hernia-
tions. J Spinal Disord Tech. 2006;19:338-343.
32. Rajasekaran S, Naresh-Babu J. Translaminar
facetal screw (Magerl’s) fixation. Neurol India.
2005;53:520-524.
33. Shim CS, Lee SH, Jung B, et al. Fluoroscopically
assisted percutaneous translaminar facet screw
fixation following anterior lumbar interbody
fusion: technical report. Spine. 2005;30:838-843.
34. Silvestre C, Mac-Thiong JM, Hilmi R, et al. Fluo-
roscopically assisted percutaneous translaminar
facet screw fixation following anterior lumbar
interbody fusion: technical report. Asian Spine J.
2012;6:89-97.
35. Xu DS, Walker CT, Godzik J, Turner JD, Smith W,
Uribe JS. Minimally invasive anterior, lateral, and
oblique lumbar interbody fusion: a literature
review. Ann Transl Med. 2018;6:104.
36. Santoni BG, Hynes RA, McGilvray KC, et al.
Cortical bone trajectory for lumbar pedicle screws.
Spine J. 2009;9:366-373.
37. Minzuno M, Kuraishi K, Umeda Y, Sano T,
Tsuji M, Suzuki H. Midline lumbar fusion with
cortical bone trajectory screw. Neurol Med Chir
(Tokyo). 2014;54:716-721.
38. Berlemann U, Heini P, Muller U, et al. Reliability
of pedicle screw assessment utilizing plain
radiographs versus CT reconstruction. Eur Spine J.
1997;6:406-410.
39. Hartl R, Lam KS, Wang J, et al. Worldwide survey
on the use of navigation in spine surgery. World
Neurosurg. 2013;79:162-172.
40. Mason A, Paulsen R, Babuska JM, et al. The
accuracy of pedicle screw placement using
intraoperative image guidance systems. J Neurosurg
Spine. 2014;20:196-203.
41. Wood M, Mannion R. A comparison of CT-based
navigation techniques for minimally invasive
WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2020.05.071
SPINE HEALTH SPECIAL SECTION
EVOLUTION OF LUMBAR MIS SURGERY
lumbar pedicle screw placement. J Spinal Disord
Tech. 2011;24:E1-E5.
42. Silbermann J, Riese F, Allam Y, et al. Computer
tomography assessment of pedicle screw place-
ment in lumbar and sacral spine: comparison
between free-hand and O-arm based navigation
techniques. Eur Spine J. 2011;20:875-881.
43. Bourgeois AC, Faulkner AR, Bradley YC, et al.
Improved accuracy of minimally invasive trans-
pedicular screw placement in the lumbar spine
with three-dimensional stereotactic image guid-
ance: a comparative meta-analysis. J Spinal Disord
Tech. 2014;28:324-329.
44. Waschke A, Walter J, Duenisch P, et al. CT-navi-
gation versus fluoroscopy-guided placement of
pedicle screws at the thoracolumbar spine: single
center experience of 4,500 screws. Eur Spine J.
2013;22:654-660.
45. Bederman SS, Hahn P, Colin V, et al. Robotic
guidance for S2-alar-iliac screws in spinal
deformity correction. Clin Spine Surg. 2017;30:
E49-E53.
46. Hyun SJ, Kim KJ, Jahng TA, et al. Minimally
invasive robotic versus open fluoroscopic-guided
spinal instrumented fusions: a randomized
controlled trial. Spine (Phila Pa 1976). 2017;42:
353-358.
47. Kantelhardt SR, Martinez R, Baerwinkel S, et al.
Perioperative course and accuracy of screw
positioning in conventional, open robotic-guided
and percutaneous robotic-guided, pedicle screw
placement. Eur Spine J. 2011;20:860-868.
48. Keric N, Doenitz C, Haj A, et al. Evaluation of
robot-guided minimally invasive implantation of
2067 pedicle screws. Neurosurg Focus. 2017;42:E11.
49. Urakov TM, Chang KH, Burks SS, et al. Initial
academic experience and learning curve with
robotic spine instrumentation. Neurosurg Focus.
2017;42:E4.
Conflict of interest statement: M. P. Steinmetz discloses
consulting for Biomet Spine, outside the submitted work.
Received 9 April 2020; accepted 7 May 2020
Citation: World Neurosurg. (2020) 140:622-626.
https://doi.org/10.1016/j.wneu.2020.05.071
Journal homepage: www.journals.elsevier.com/world-
neurosurgery
Available online: www.sciencedirect.com
1878-8750/$ - see front matter ª 2020 Published by Elsevier
Inc.