Open Spinal Fusion versus Minimally Invasive Spine Surgery: A Literature Review

Author(s): Dr. Banwari Lal Bairwa, Dr. Mohit Gupta

Background:

Spinal fusion remains a foundational intervention for degenerative disc disease, spondylolisthesis, and scoliosis. While open spinal fusion (OSF) has been the gold standard for decades, minimally invasive spine surgery (MISS) has gained prominence for its reduced perioperative burden and potential to enhance recovery. A comprehensive comparison of these techniques is necessary to evaluate their relative efficacy, safety, and adaptability across patient populations.

Objectives:

To critically compare open spinal fusion and MISS techniques from 2014 to 2024 in terms of clinical outcomes, surgical innovations, patient-specific factors, and economic viability, focusing on quantitative metrics such as fusion success, complication rates, revision frequency, operative parameters, and quality-of-life indices.

Methodology:

A systematic review of peer-reviewed literature (2014– 2024) was conducted across PubMed, Scopus, and Web of Science using predefined MeSH terms and Boolean logic. Inclusion criteria required comparative studies (RCTs, meta-analyses, systematic reviews) involving ≥50 patients with degenerative disc disease, spondylolisthesis, or scoliosis. Outcome variables included fusion rates, Visual Analog Scale (VAS) pain scores, Oswestry Disability Index (ODI), operative time, blood loss, complications, length of stay (LOS), and revision surgery rates.

Results:

MISS demonstrated significantly lower complication rates (5%–10%) compared to OSF (20%–30%) (p < 0.05), with reduced blood loss (100–200 mL vs. 400–600 mL), shorter LOS (2–3 vs. 5–7 days), and faster ambulation (up to 3.5 days earlier). Fusion rates were comparable across techniques: 80.5%–98% for MISS and 91.1%–98% for OSF (p > 0.05). MISS reduced opioid use by 30%, and in obese patients (BMI > 30), complication rates fell from 15% (OSF) to 6% (MISS, p < 0.01). Revision surgery rates were halved in MISS (14% vs. 28%, p = 0.001), although early learning curve risks were noted (OR 2.59, p = 0.003). In scoliosis, MISS achieved equivalent Cobb angle correction (≈70%) with 50% less blood loss. Quality-of-life outcomes (ODI, EQ-5D, VAS) converged by 2–5 years across all conditions (p > 0.05).

Conclusion:

MISS provides equivalent long-term efficacy to OSF in spinal fusion while conferring significant perioperative advantages, reduced revision rates, and enhanced recovery—particularly in paediatric, elderly, and obese populations. Despite initial technical challenges and reliance on advanced technology, its integration of endoscopic, robotic, and awake techniques positions MISS as a leading strategy for modern spinal care. Further long-term, condition-specific RCTs are warranted to optimize patient stratification and refine adoption.