Minimally Invasive Spine Surgery: A Patient’s Guide to Spine Care

By Dr. Joseph Mejia, DO, FAAPMR
Medical Director, Performance Ortho

At Performance Ortho, our team of physicians and spine surgeons understands the fear, uncertainty, and confusion that often come with the decision to pursue spine surgery. It’s a significant choice, one that demands clear education, active patient involvement, and a shared understanding between the provider and patient.

Spine surgery is a highly specialized and complex area of medicine. Dr. Mejia’s goal is to provide a high-level overview to help patients better understand when spine surgery may be appropriate, the types of procedures that might be recommended, and the common concerns we’ve seen in over 15 years of clinical experience. Our aim is to ensure every patient feels informed, supported, and confident throughout the decision-making process.

Do I Need Spine Surgery?

“Do I need spine surgery?” This may be the most common question I’m asked by patients experiencing back pain,” explains Dr. Mejia.

“According to most clinical research, only about 10% or fewer of patients with spine-related pain are actual candidates for surgery. In my own experience of more than a decade and a half of clinical practice, I believe that number is even lower-closer to 5%,” concludes Dr. Mejia.

While there are some clear-cut situations where surgery should be considered promptly, the majority of cases fall into a gray zone where a personalized, conservative approach is more appropriate. Below are some definitive medical scenarios where spine surgery should be considered sooner rather than later:

When to Consider Spine Surgery Promptly:

• Loss of bowel or bladder function (known as cauda equina syndrome)
• Numbness or loss of sensation in the groin or rectal area (saddle anesthesia)
• Spinal infection, abscess, or tumor
• Sudden or progressive loss of strength in the arms or legs, such as:
  • Foot drop
  • Signs of spinal cord compression (myelopathy)

Dr. Mejia explains further, “In the absence of any of the above ‘red flags,’ a more conservative and integrated approach to managing spinal pain is typically warranted. I am a firm believer in a conservative-to-aggressive treatment model, grounded in a fully integrated approach to care. The most effective outcomes occur when spine surgeons, interventional pain physicians, and rehabilitation specialists work together—under one roof, in a truly team-based model. This collaborative strategy acknowledges that each specialty brings unique expertise to the table, and that collectively, we can achieve far more. A patient should begin considering spine surgery only after a comprehensive, non-surgical treatment plan has been thoroughly explored and exhausted, particularly if they are not experiencing meaningful symptom relief or improvement in function and mobility.”

While every patient’s condition is unique and should be evaluated individually, there are some general guidelines that may indicate when spine surgery should be considered:

• 6 to 12 weeks of consistent, structured conservative care is a common initial benchmark for most complex spine conditions like herniated discs, degenerative disc disease, or stenosis.
  • This includes spinal injections, physical therapy, pain medications, and spinal decompression therapy.
  • Patients should experience improvements measured at 25% to 50% during this time; if not, a surgical consult is warranted.
• If the patient is stable (25% to 50% or more reduction in pain) but not improving over 3 to 6 months, or quality of life remains significantly impacted, surgical intervention may be needed.
• In chronic conditions (pain > 6 months), with a pattern of acute-on-chronic pain flare-ups, despite all non-surgical options being exhausted, surgery should be considered.

Understanding Spine Surgery

If a patient has truly exhausted all appropriate conservative interventions, they may become a strong candidate for spine surgery. Dr. Mejia explains, “Anecdotally, I’ve observed that patients who commit to and complete a comprehensive conservative treatment plan tend to have significantly better outcomes after surgery compared to those who are fast-tracked into it. Perhaps this is because some of those rushed into surgery were never ideal surgical candidates to begin with.”

Two Main Types of Spine Surgery: Open vs. Minimally Invasive

Open Spine Surgery is a more traditional approach where a larger incision is made across the midline of the spine. This allows the surgeon to directly see and work on the spine. A surgeon may elect an open procedure for more complex or advanced spinal conditions such as advanced spinal instability, tumors, infections, or spinal problems at multiple levels.

The downside of open spinal procedures is that they require significant spinal muscle disruption and a much longer recovery time, including extensive rehabilitation. Most common open spinal surgeries include:

• Multi-level Discectomy (lumbar)
• Multi-level Laminectomy
• Spinal Fusion with hardware
• Posterior Cervical Fusion

Minimally Invasive Spine Surgery (MISS) has made significant advancements over the past 25 years, largely driven by improvements in computer-assisted imaging and surgical technology. Today, spine surgeons can treat many conditions using small incisions and specialized instruments, often guided by microscopes or high-definition cameras. This approach allows access to the spine with minimal disruption to surrounding muscles and tissue.

MISS is particularly well-suited for less complex, single-level conditions such as herniated discs, spinal stenosis, and certain types of spinal instability. Because the technique is less invasive, patients often experience less post-operative pain, smaller scars, and a quicker return to activity. Additionally, rehabilitation needs are typically reduced, as more of the body’s natural structure—especially muscle—is preserved.

Some common MISS procedures include:

• MILD Procedure
• Minuteman Procedure
• Vertiflex Procedure
• Kyphoplasty Procedure

In Summary

As you can see, managing spinal pain can be complex, confusing, and frustrating—both for patients and providers. That’s why it’s important to seek care from professionals who have experience in both non-operative and surgical treatments.

As mentioned earlier, a team-based approach is often the most effective for complex spine conditions like herniated discs, degenerative disc disease, or spinal stenosis. This type of collaborative care not only improves outcomes but can also reduce the likelihood that surgery will be needed.

However, if spine surgery becomes necessary, a minimally invasive (MISS) approach should be strongly considered when appropriate. Outcomes are often best when the surgeon works closely with the pain management team and rehabilitation specialists before and after surgery, ensuring a coordinated, comprehensive plan of care.

Why Performance Ortho?

For over 25 years, Performance Ortho has been a trusted leader in orthopedic, spine, and pain care in Somerset County, New Jersey. Our difference lies in our integrated team approach: orthopedic surgeons, pain specialists, physical therapists, and occupational therapists all work together, side by side, in one facility.

With convenient locations in Watchung, Branchburg, Somerset, Hillsborough, and a state-of-the-art Surgery Center in Bridgewater, we make it easy for you to get the expert care you need.

Take the First Step Toward Relief

If spine pain is keeping you from living your life, don’t wait. Schedule a consultation with our team and explore what treatment options could be right for you. Relief is possible—without ongoing frustration and without giving up on the life you love.

Meet Your Expert: Dr. Joseph Mejia

Dr. Mejia is a triple board-certified specialist in Pain Management, Physical Medicine & Rehabilitation, and Sports Medicine. With over 15 years of experience, he has helped thousands of patients restore function, reduce pain, and avoid unnecessary surgery.

He currently serves as Medical Director at Performance Ortho, with offices in Watchung, Branchburg, Somerset, and Hillsborough, NJ.

Next Steps: How to Get Evaluated

At Performance Ortho, we specialize in surgical and non-surgical, evidence-based treatments that change lives. If you’re struggling with acute or chronic spine pain, we may provide the solutions you are looking for.

Schedule an Appointment or Call Today and Reclaim Your Mobility-908-756-2424
The first step toward a pain-free future starts here.