Evolving technological sophistication has resulted in ongoing modifications of traditional surgical approaches to correct disorders of the spinal axis. Advances in instrumentation and pre- and intraoperative imaging have fueled a move toward minimally invasive, minimal access spine surgery (1), by which the same surgical goals of conventional open techniques are met through a smaller access corridor. An early and now well-accepted example is the surgical approach to a herniated paracentral lumbar disc, originally performed via complete laminectomy and now performed by microsurgical discectomy thorough a 15-25-mm incision and hemilaminectomy.

This chapter reviews current concepts in minimal access spinal surgery. We first focus on modifications of traditional posterior and anterior approaches and then evaluate the increasing role of completely novel approaches, such as kyphoplasty for the treatment of vertebral compression fractures or the use of intraoperative magnetic resonance imaging (MRI) to define surgical anatomy better. Lastly, we discuss advances in biologic instrumentation such as bone morphogenetic proteins and bioabsorbable polymers.

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