ABSTRACT
This chapter discusses the considerations that go into the patient selection process for a minimal access spinal procedure. Minimally invasive spinal surgery (MISS) is a developing field of surgery allowing surgeons to perform spinal procedures through smaller incisions. The primary intention of MISS is to limit the collateral damage to the spinal soft-tissue envelope, thus diminishing postoperative pain and allowing earlier recovery and return to activities. Revision spinal surgery is always more difficult than primary spinal surgery because of scaring of the perispinal tissue. A particularly challenging situation arises when the revision procedure requires a decompression of the spinal canal through an area of severe scaring as might be seen in a case of recurrent disc herniation. Patient selection is generally considered to be the most important issue predicting success of any spinal procedure. Despite this, patient selection has many variables and remains one of the most challenging aspects of spinal practice.
