Minimally invasive spine surgery encompasses all surgical techniques that treat spinal pathology with the least possible damage to healthy tissue. In contrast with traditional open surgery — which required incisions of several centimetres and extensive separation of the paravertebral musculature — these techniques work through millimetric incisions, preserving anatomy and significantly reducing post-operative pain, hospital stay, and recovery times.
At the Mediterranean Spine Institute (ICEM), located inside Hospital La Salud in Valencia, Dr. Antonio Vilatela and Dr. Pablo Jover practise the full range of minimally invasive spine surgery, choosing the technique that best fits each patient.
What is minimally invasive spine surgery?
It is a set of surgical procedures that share three principles:
- Millimetric incisions (5–25 mm depending on the technique) compared to 4–10 cm in open surgery.
- Muscle preservation: instead of cutting through the musculature, access is made between fibres without disrupting their attachment.
- Magnified visualisation: the surgeon works with an endoscope, microscope, or tubular dilator, viewing the surgical field magnified on a high-definition monitor.
The therapeutic goal (decompressing a nerve, removing a herniated fragment, widening a stenotic canal, or stabilising a segment) is achieved as effectively as in open surgery, but with far less impact on the body.
Techniques we practise at ICEM
Monoportal endoscopic spine surgery
A single 7–10 mm incision through which the endoscope and its integrated instruments are introduced. Indicated for selected lumbar and cervical disc herniations, recurrent cases, and localised root compressions.
Biportal endoscopic spine surgery (UBE / ESUBE)
Two independent 5–8 mm incisions: one for the endoscope, one for the instruments. Provides greater range of motion and allows treatment of more complex conditions, such as lumbar canal stenosis. This is our flagship technique.
Tubular microsurgery
Access through an 18–25 mm tubular dilator that separates muscle without cutting. The surgeon works under a surgical microscope. Indicated when greater exposure is required while preserving the minimally invasive principle.
Minimally invasive microdiscectomy
A specific variant for lumbar and cervical disc herniations. Combines the advantages of the microscope with the smallest possible incision to resolve nerve root compression.
MIS-TLIF and percutaneous fusion
When the condition requires fusion (vertebral fixation with screws), minimally invasive techniques (MIS-TLIF, percutaneous) allow the implants to be placed through millimetric incisions guided by navigation or fluoroscopy, avoiding the wide dissection of classic open surgery.
When is minimally invasive surgery indicated?
- Lumbar or cervical disc herniation not responding to conservative treatment after 6–12 weeks, or causing neurological deficit.
- Lumbar canal stenosis with neurogenic claudication that limits quality of life.
- Facet joint syndrome with mechanical pain unresponsive to repeated injections.
- Symptomatic grade I–II spondylolisthesis with associated compression.
- Synovial cysts and other localised root compressions.
- Recurrences following previous surgery, in selected cases.
Not every patient or condition is a candidate: severe deformities, multilevel instabilities, tumours, or infections may still require classic open surgery. An individual evaluation with up-to-date imaging (MRI and/or CT) is essential.
Advantages over traditional open surgery
| Aspect | Minimally invasive | Classic open |
|---|---|---|
| Incision | 5–25 mm | 4–10 cm |
| Muscle damage | Minimal or none | Significant |
| Bleeding | Very low | Moderate–high |
| Hospital stay | 0–1 night | 3–5 nights |
| Post-op pain | Low, controlled with oral analgesia | Moderate–high, requires intensive regimen |
| Return to work* | 2–4 weeks (non-physical) | 6–12 weeks |
| Infection risk | Very low | Low–moderate |
| Scar | Almost imperceptible | Visible |
*Approximate timelines depending on pathology and type of work.
How is recovery?
- Day 0–1: the patient walks the same day of surgery. Hospital discharge in less than 24 hours in most cases.
- Week 1–2: light daily activity, avoiding lifting and driving.
- Week 2–4: targeted rehabilitation, return to non-physical work.
- Month 2–3: moderate sport activity under medical guidance.
- Month 3–6: full return to previous activity, including high-impact sports.
Expected outcomes
Available scientific evidence shows that, in correctly selected patients, minimally invasive techniques deliver medium- and long-term clinical results equivalent or superior to classic open surgery, with the added benefit of lower perioperative morbidity.
- Improvement of radicular pain: 85–95% of patients at 3 months.
- Recovery of motor function (when previously deficient): 75–90%.
- Major complication rate: <2%.
- Symptomatic recurrence rate at 5 years: 5–10%.
- Patient satisfaction with outcome: >90%.
Minimally invasive spine surgery in Valencia
At ICEM (Mediterranean Spine Institute), inside Hospital La Salud Valencia, we offer the full spectrum of minimally invasive spine techniques, always selecting the most appropriate one for each case. The technique is never chosen by trend: it is chosen based on what the patient needs and what the scientific evidence supports.
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Frequently asked questions
Can any disc herniation or stenosis be operated minimally invasively?
No. The technique is indicated for correctly selected patients based on the exact location of the lesion, individual anatomy, presence or absence of instability, and other factors. A massive herniation with associated instability or a severe multilevel stenosis may require open surgery. A presential evaluation with updated imaging studies is essential.
How long until I can return to work?
Depends on the technique and the type of work. In office work, most patients return between 2 and 4 weeks. In physical or load-bearing jobs, the typical timeline is 6 to 8 weeks.
Which surgeon should perform my surgery?
Minimally invasive spine techniques require specific training and a demanding learning curve. It is legitimate and advisable to ask the surgeon about their concrete experience with the technique, especially in endoscopic spine surgery.
This article is informative and does not replace medical judgement. Always consult a specialist for your particular case.