Minimally invasive spine surgery with endoscopy, navigation, robotics, and artificial intelligence: Clinical evidence and future directions

Figure 1 Innovation and clinical efficacy of minimally invasive spine surgery. The central illustration shows the human spine, surrounded by five key domains related to minimally invasive spine surgery (MISS): (1) Technological innovations: The development of spinal endoscopy, image-guided navigation, intraoperative computed tomography/three-dimensional fluoroscopy, robotics, and artificial-intelligence-assisted planning enables more precise and less invasive spinal procedures; (2) Procedures: Representative MISS techniques include percutaneous endoscopic discectomy, endoscopic decompression for spinal canal stenosis, minimally invasive transforaminal lumbar interbody fusion, lateral and extreme lateral interbody fusion, and percutaneous tumor ablation combined with vertebral cement augmentation; (3) Clinical indications: Common indications comprise degenerative disc disease, lumbar spinal stenosis, spinal deformity, and spinal tumors or infections; (4) Clinical outcomes: Compared with conventional open surgery, MISS is associated with reductions in pain visual analogue scale, disability (Oswestry Disability Index), intraoperative blood loss, length of hospital stays, and procedure-related complications, together with improved quality of life; and (5) Challenges and future directions: Current limitations include a steep learning curve, radiation exposure, indication selection, and high costs, whereas future development is expected to rely on artificial-intelligence-based navigation, augmented/virtual-reality and telesurgery platforms, personalized three-dimensional-printed implants, and biomaterials- and tissue-engineering-based strategies. CT: Computed tomography; 3D: Three-dimensional; AI: Artificial intelligence; PED: Percutaneous endoscopic discectomy; MIS-TLIF: Minimally invasive surgery-transforaminal lumbar interbody fusion; LLIF/XLIF: Lateral and extreme lateral interbody fusion; DDD: Degenerative disc disease; VAS: Visual analogue scale; ODI: Oswestry Disability Index; QoL: Quality of life; AR/VR: Augmented/virtual-reality.