Clearing the Confusion on Spinal Surgery: World-Renowned Expert Dr. Kaixuan Liu Talks About Minimally Invasive Techniques

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Recently Dr. Kaixuan Liu spoke about some of the new advances in spinal surgery an how they can seem like a dream come true. Dr. Liu explains how many patients are confused by the various claims: “Minimally invasive” surgery sounds great, but what, exactly, does it involve?

Endoscopic Spine Surgeon

Kaixuan Liu MD, PhD

Your ultimate goal should be to reduce your back pain while keeping complications to a minimum.

To anyone suffering from chronic back pain, new advances in spinal surgery can seem like a dream come true. But many patients are confused by the various claims: “Minimally invasive” surgery sounds great, but what, exactly, does it involve?

“The term ‘minimally invasive spine surgery’ can apply to two very different types of surgeries,” says Kaixuan Liu MD, PhD, chief surgeon at Atlantic Spinal Care in Edison, N.J. The term ‘minimally invasive’ was coined in the 1980s to differentiate this new technique from traditional “open” spinal surgery, in which the surgeon made a large incision in order to get to the tissues in and around the spinal column. Minimally invasive techniques use an endoscope, a telescope-like device that carries a tiny camera that allows the surgeon to see the tissues that need his attention without cutting into the surrounding skin and muscle, meaning much less trauma, pain and recovery time.

But there are big differences in the minimally invasive procedures available today. “One type of minimally invasive surgery is Mini-Open (or Microscopic) Surgery,” explains Dr. Liu. Although light-years ahead of old-fashioned open surgery, it involves one or more good-sized incisions (typically one to three inches long). In a Mini-Open surgery, the doctor uses the endoscope (or another type of microscopic camera) for assistance, but still relies on traditional cutting techniques for some of the procedure. The patient receives general anesthesia and the surgeon may remove sections of bone or muscle. Recovery time is generally two to three months.

The other type of minimally invasive surgery, called Endoscopic Spine Surgery(or Full-Endoscopic), requires only one small incision, typically less than a half-inch long. This is True Minimally Invasive Surgery, as it truly is less invasive than either open or mini-open techniques. It doesn’t involve the removal of tissue and in most cases requires only local anesthesia. Typical recovery time is four to six weeks.

“It’s important for patients to understand the differences between these procedures,” Dr. Liu says. For example, some surgeons offer “Endoscopic-Assisted Spine Surgery,” which is not the same thing as True Minimally Invasive Spine Surgery (or Full-Endoscopic). “Surgeons can use endoscopes in open surgeries, too,” he explains. “Just using an endoscope doesn’t make the procedure minimally invasive.” In other words, endoscopic surgery is minimally invasive, but not all surgery with endoscopic assistance is minimally invasive.

Of course, Dr. Liu notes, having a small incision isn’t the only concern. “The goal of any surgery is to fix a medical problem,” Dr. Liu says. “In the case of spine surgery, it’s often to relieve pain by removing the pain generator—a bone spur or disc herniation.” But the spine is a very delicate and complex structure, he says, and not all pain generators can be easily accessed through a small incision.

“Your ultimate goal should be to reduce your back pain while keeping complications to a minimum.”

About Dr. Liu:
Kaixuan Liu, M.D., Ph.D., is a renowned endoscopic spine surgeon and founder of Atlantic Spinal Care, LLC, in Edison, New Jersey (

Dr. Liu is certified by The American Board of Pain Medicine and The American Board of Anesthesiology, and is a member of The International Society for Advancement of Spine Surgery, The American Society of Interventional Pain Physicians (ASIPP), The American Academy of Pain Medicine (AAPM), The International Intradiscal Therapy Society (IITS), and The American Society of Anesthesiologists (ASA). He also serves as an international surgeon for The Spinal Foundations in England.

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