Conditions & Treatments

Minimally Invasive Spine Surgery

What’s the difference between traditional spine surgery and Minimally Invasive Spine Surgery (MISS)?

The goal of traditional spine surgery is to access and remove diseased and damaged bone and discs in order to take pressure off of the spinal cord or compressed nerves, and to stabilize the spine. The goal of MISS is the same, but can be achieved in a less invasive manner, to stabilize the spinal bones and joints, to relieve pressure on spinal nerves, and reduce the risk of soft tissue injury.

Traditional spine surgery requires a long, 5 to 6-inch incision, to allow the surgeon to see the spine. During traditional spine surgery the muscles are pulled aside or cut to provide access to the spine, and to place screws, cages, and bone grafts to stabilize the bones.

A significant disadvantage of traditional open surgery is the pulling and cutting of the muscles to allow for direct vision, which results in damage to the soft tissues, pain and an extended recovery. MISS was developed to reduce the risk of injury to the soft tissues. The surgeon can use smaller incisions which reduces bleeding and provides a quicker recovery.

Traditional spine surgery also causes significant bleeding. However, newer blood preservation techniques lessen blood loss and post operative transfusion can be accomplished with blood lost during surgery through blood recovery techniques. MISS is not associated with significant blood loss.

Most spinal surgery can be accomplished with MISS. However, certain conditions may require open surgery. At South County Orthopedic Specialists (SCOS) in Orange County, California, our spine surgeons will determine your best options based on your condition.

What conditions can be treated with MISS?

  • Degenerative Disc disease
  • Herniated Discs
  • Artificial Disc replacement
  • Lumbar Spinal Stenosis
  • Lumbar fusion
  • Sciatica
  • Spinal deformities like scoliosis
  • Spinal infections
  • Spine instability
  • Spinal tumors
  • Compression fractures of the vertebrae
  • Decompression for a pinched nerve

What are the advantages of MISS?

  • Minimal blood loss
  • Shorter surgery
  • Less anesthesia
  • Smaller incisions
  • Smaller and more aesthetically pleasing scars
  • Less post-operative pain
  • Fewer pain medications
  • Less risk of muscle damage
  • Less risk of infection
  • Shorter hospital stays and outpatient surgery

What are the risks?

As with traditional spine surgery, complications are similar, but studies show that MISS reduces the risk of infection.

As with all surgical procedures there is a risk of:

  • Bleeding
  • Infection
  • Pain and discomfort
  • Nerve damage
  • Poor reaction to anesthesia
  • Recurrence of original symptoms
  • Blood clots

The MISS Procedure

MISS specially trained surgeons employ a variety of advanced technologies such as lasers, endoscopes, operating microscopes, and computer assisted surgical navigation systems.  MISS is performed through the skin (Percutaneous) or through a small incision (mini-opening). To assure correct placement of the endoscopic tools, placement of the endoscope may be guided by fluoroscopy- a real-time x-ray.

Instead of cutting the spinal muscles, in MISS the surgeon will spread and dilate the muscles to gain access to the spine. This reduces or eliminates damage to the muscles and allows for quicker recovery.

MISS is a delicate, complex, highly technical procedure which requires significant training and experience. The SCOS Spine Fellowship Trained, board certified spine surgeon Dr. Bryce Johnson, is specially trained in MISS, with years of experience. He is your best choice for successful spine surgery in Orange County, California. 

Special MISS surgical techniques are adapted for use based on the condition to be treated.


Recovery is different for each patient. Because of smaller incisions and minimal blood loss in MISS, many patients can have same day surgery and go home after the procedure. But recovery depends on the specific procedure, and may require an over-night hospital stay.

Due to the large incisions, dissection of the spinal muscles and blood loss that occurs in open spine surgery, recovery is generally twice as long as that with MISS.

MISS for the elderly and those with serious medical conditions

More than 80% of older Americans suffer from back pain. Most often it is due to lumbar spinal stenosis, which is often debilitating and destroys their quality of life.  MISS is a great option for older patients because invasive, traditional spine surgery creates a higher risk of complications and requires longer recoveries. Furthermore, patients over the age of 65 often have serious medical conditions that preclude them from undergoing open back surgery. For this group, MISS is extremely beneficial, because prior to the development of MISS, surgeons were reluctant to perform open surgery, leaving conservative treatments like physical therapy, pain management and pain medications the only options for older patients. MISS is a safe and effective alternative to open spine surgery.

It is important for patients to understand that surgery is the last resort, and will be entertained when non-surgical approaches have failed to improve the patient’s symptoms. You can feel confident that the SCOS spine surgeon, Dr. Bryce Johnson has the skills and expertise to treat your spine disorders using the latest surgical techniques, and state-of-the-art technologies. SCOS offers safer, faster and less invasive options to get your life back.

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