Impact of Minimally Invasive Spine Surgery Training on Surgeon Practice and Perceptions

Objective: This study aimed to further characterize the relationship between minimally invasive spine surgery (MISS) training background, clinical utilization, and procedural techniques, and to assess how these factors influence surgeons’ perceptions of MISS outcomes relative to open surgery.Methods: An online survey was distributed via social media and email to members of AO Spine and AANS (American Association of Neurological Surgeons) who identified “spine” as a subspecialty. Eligible surgeons completed questions regarding their clinical practice patterns and perceptions of MISS, with a focus on procedures performed in the lumbosacral (L1–S1) region. Responses from neurosurgeons and orthopedic surgeons were compared using the Fisher exact test. Multivariable ordinal logistic regression models were then applied to examine associations between surgeon characteristics and perceptions of procedural time, complication rates, and postoperative outcomes.Results: Among 131 respondents, 103 were neurosurgeons and 28 were orthopedic surgeons. Neurosurgeons reported greater experience with MISS and utilized a broader range of MISS techniques than orthopedic surgeons (p<0.05), although neither group reported using endoscopic techniques. Surgeons who performed more than 50% of decompressions or discectomies using MISS perceived shorter procedural times compared with open techniques (p<0.005). Higher MISS procedural volume was also associated with lower perceived complication rates for decompressions (p=0.046); however, orthopedic surgeons were more likely to perceive higher complication rates, particularly for discectomies (p=0.019). Fellowship training and higher MISS volume were associated with lower perceived revision rates (p=0.005). Lower blood loss was consistently perceived with MISS, irrespective of surgeon characteristics.Conclusion: This study highlights a complex relationship between MISS training, clinical experience, and surgeon perceptions, demonstrating that greater exposure and procedural volume are associated with more favorable views regarding efficiency, safety, and patient outcomes. Despite patient preference and an expanding body of evidence supporting MISS, hesitancy persists, potentially due to technical demands, steep learning curves, and limited long-term outcome data. These findings underscore the importance of early, structured MISS training and emphasize the need for further research to bridge the gap between patient expectations and surgical practice.