Carbon Footprint of Minimally Invasive and Open Microdiscectomy: Emerging Implications

Study Design Retrospective cohort study. Objective To quantify and compare the carbon footprint (CF) of open and MIS microdiscectomy. Methods The study included 161 patients undergoing primary 1 level open or minimally invasive surgery (MIS) for lumbar disc herniation between 2018 and 2022. Life cycle assessment (LCA) modeling was used to calculate the CF produced during the distribution, use and waste phases of each item used during surgery. Independent samples t-tests and Chi square or Fischer’s exact tests were used to compare the CF of open and MIS procedures. Results There were 161 cases (100 MIS, 61 Open). MIS had a significantly higher overall CF (114.67 ± 60.06 kg-CO 2 e) vs open surgery (95.15 ± 45.45 kg-CO 2 e, P = 0.021). Key contributors included disposable surgical supplies, energy-intensive OR equipment, and anesthetic gases. Only the waste phase had a significant difference in CF, with MIS producing more waste (MIS: 31.50 ± 25.67; Open: 18.18 ± 10.25; kg-CO 2 e; P < 0.001) and consuming more energy, especially for heating, ventilation, and air conditioning systems and fluoroscopy. Conclusions MIS microdiscectomy results in higher CF and environmental costs compared to open procedures, highlighting the need for sustainable practices, especially waste reduction, use of reusable materials and optimized energy use in ORs. A multifaceted approach is crucial to mitigate the environmental impact of spine surgeries and should be applied to both MIS and open techniques.