Keyhole Spine Surgery

Keyhole spine surgery, a type of minimally invasive spine surgery (MISS), refers to any surgical technique involving minimal to no trauma to the muscle yet achieves the same surgical results. Evolving for decades and recently experiencing significant advancement, the technology around this procedure has been refined, allowing it to perform on increasingly complex procedures. 

This technique uses special instruments including retractors and tubes that allow the surgical procedure to be carried out safely and effectively through a smaller window, minimizing harm caused as well as decreasing healing time. Surgeons pass endoscopic tools through a very small incision or thin tube, utilizing real time imaging and navigation systems to guide the tools to the exact location. A tiny camera provides a direct view while another tool provides light, allowing the surgeon to then pass through  specialized, thin instruments through the retractor to perform the surgical tasks. This proves to be a safer alternative to conventional spinal surgery, which requires overlying muscles to be detached or stripped from the bone. This exposes the area of the spine to allow the surgeon to perform the surgical procedure, but may also result in exposed bleeding surfaces of the muscles as well as extra damage to the nerve supply of the muscles. 

In comparison to conventional surgical procedures, keyhole procedures require specially trained surgeons and specialized instruments, drastically increasing the cost of surgery. At times, surgeons may have to convert from using keyhole procedures to conventional procedures on the table to ensure the surgery is completely safe and effective for the patient, rendering attempts unnecessary. However, successful keyhole surgery avoids the need of extensive stripping of the muscles, allowing the patient to experience less pain in the post-operative period and return to normal function earlier. Additional costs are also usually voided as there is shortened hospital stay, less use of pain medicines, and quicker return to work post op. 

Any open procedure can be carried out through the keyhole technique, and it is up to the patient's anatomy to determine whether this course of action is appropriate. If so, this technique can be employed on discectomies, decompression, spinal fusion, fracture fixation, deformity correction, and much more procedures as long as the attending surgeon sees it fit. In general, keyhole spine surgery has an extremely high patient satisfaction rate, exceeding 90%, while success rate ranges comfortably from 80% to over 90% (depending on the specific condition and complexity of the case). This technique continues to be explored and refined, bringing more and more patients safety and relief to this day.

by Renee Wang at Incisionary

References

Centre for Orthopaedics. (n.d.). Keyhole Spine Surgery. Spine Surgery. https://cfo.com.sg/keyhole-spine-surgery/

Cleveland Clinic. (n.d.). Minimally Invasive Spine Surgery: Procedure, Risks & Benefits. Retrieved October 21, 2025, from https://my.clevelandclinic.org/health/treatments/17235-minimally-invasive-spine-surgery