Vaccaro AR. Controversies in Spine Surgery, MIS versus OPEN: Best Evidence Recommendations. Thieme; 2018; 264 pp; 51 ill; $149.99

Controversies in Spine Surgery, MIS versus OPEN: Best Evidence Recommendations is a 239-page single-volume hardcover including 51 high-quality clinical, radiographic, and intraoperative full-color images to guide the reader through a controversial debate about minimally invasive versus open spinal procedures.

The main authors of this text include the world’s most influential spine surgeons and are supported by a host of leading experts in the field, which are listed as collaborators. After sincere dedications and a preface by its primary authors outlining their inspirations and motivations for writing this book, the content is laid out in 4 parts divided into 24 total chapters. Each chapter attempts to answer a specific clinical question and has its own introductory section providing background information and surgical indications for each topic to be discussed.

At least one open- and one minimally-invasive supporting author were involved in the production of every chapter. Following this, the chapters are organized in a “duel” and “duet” debate fashion where the advantages, surgical techniques, supporting evidence, and complications are interchangeably compared and contrasted for both MIS and open spinal procedures. Surgical techniques are described in great detail including patient preparation and positioning, preferred image guidance technique, descriptive surgical dissection technique and adjuvants for blood loss control, venous thromboembolism prophylaxis, and use of microscope assisted surgery, if pertinent.

Additionally, every chapter includes at least one case scenario with a clinical vignette and its corresponding imaging about the topic being discussed. All provided images are of good quality and appropriately labeled with detailed descriptive legends that adequately correlate to the referenced topic. Chapters conclude with an editor’s commentary, where the book’s editors summarize the pros and cons of MIS versus open spinal procedures for that specific clinical scenario. Evidence is presented and objectively analyzed with opposing sides presenting differing opinions and techniques resulting in a synchronous collection of pros and cons. References are provided at the end of each chapter and include a comprehensive selection of the latest, most significant literature available to date. Summary tables of the literature and complications by approach are also provided.

Part 1 of this book consists of 15 chapters, which focus on degenerative spinal conditions such as lumbar stenosis, facet cysts, degenerative spinal deformity and disc herniations, lumbar adjacent segment degeneration, degenerative scoliosis, flatback syndrome and thoracic disk herniations. It also discusses technical issues such as complications of instrumentation and dural tears. This part is probably the most relevant for the community providers, since these topics include common reasons patients present to the spine care provider.

Chapter 15 discusses a hot topic in describing how minimally invasive spine surgery may broaden the scope for spinal procedures in the geriatric population. This, and advances in anesthesia, could greatly broaden the indications for spinal surgery and allow the geriatric population to benefit from these quality-of-life improving procedures. Part 2 focuses on spinal trauma and includes a thorough discussion of MIS versus open approaches for the management of thoracolumbar burst and cervical spine fractures. Minimally invasive surgery has experienced an enormous leap in this scenario, with some claiming its superiority, as it may lead to decreased blood loss, surgical time, and soft tissue disruption, as well as a shorter hospital stay.

Part 3 discusses oncological conditions of the spine including metastatic and intradural spine tumors. It provides information regarding tumor resection and stabilization, quality of life issues and potential advantaged and risks of MIS techniques. This part concludes with a thought-provoking chapter, which discusses the potential roles of MIS spinal procedures in advanced spinal tumors for quality-of-life improvement and palliation.

Part 4 of this book reviews miscellaneous topics, including differences in radiation exposure for MIS vs open techniques. It also includes an analysis of three dimensional navigational imaging to improve surgical outcomes and reduce radiation exposure and time of operation. MIS procedures have been reported to expose the patient and surgical team to higher levels of ionizing radiation when fluoroscopic guidance is used. However, whether this increase has any occupational or clinical significance continues to be unknown. This book is extraordinarily comprehensive and the authors leave no stone unturned with the level of detail discussed for each specific topic. Overall, the organization of this book with chapters discussing specific topics of interest in a debate-like fashion allows readers to feel as though they are apart of a panel discussion with the world’s leading experts leading each topic. Its goal is not to convince that one approach is better than the other, but to provide the necessary supportive evidence for readers to assimilate this information and draw their own conclusions, which could be applied to their particular practice and patient population.

This book is an exceptional tool to guide spine-care providers as they make important evidence-based decisions on providing the most optimal spine treatment for a specific patient. It is a must-have resource for all entry-level and well-experienced practitioners involved in treating patients with spinal conditions. For the neuroradiology audience, this publication would be of immense value for identifying important radiographic findings that may assist the spine-care team in determining whether an open- versus a minimally- invasive approach would be the optimal procedure for a particular patient. This book may also be of significant value for better understanding the details of the procedure performed when evaluating post-operative imaging.