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This systematic review synthesized evidence on overall and approach-specific complications of thoracic MISS using tubular, uniportal endoscopic, and biportal endoscopic techniques. Following PRISMA guidance, databases were searched (Jan 2013–Mar 2024) for adult studies reporting complication rates. Nine retrospective studies (234 patients) showed overall complication rates from 0% to 42.9%, with neural injuries and dural tears most frequently reported.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/complications-in-thoracic-minimally-invasive-spine-surgery-20132024-a-systematic-review/461505/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/complications-in-thoracic-minimally-invasive-spine-surgery-20132024-a-systematic-review/461505.png","ImageObject",300,407,{"name":92,"@type":93},"SANS","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What complication outcomes were evaluated in this systematic review?","Question",{"text":112,"@type":113},"The review evaluated overall complication rates and approach-specific complications after thoracic minimally invasive spine surgery using tubular, uniportal endoscopic, and biportal endoscopic techniques.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were eligible studies identified and assessed for quality?",{"text":117,"@type":113},"Databases including PubMed, Medline, Embase, and the Cochrane Library were searched from January 2013 to March 2024 for adult studies reporting complication rates. Study quality was assessed using the Newcastle–Ottawa Scale.",{"name":119,"@type":110,"acceptedAnswer":120},"What complications occurred most often across included studies?",{"text":121,"@type":113},"Neural injuries and dural tears were the most frequently reported complications, with rates ranging from 0% to 14.3% for neural injuries and 0% to 3.6% for dural tears.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},461505,1790926462,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":41},962090760505,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Systematic Review  \nComplications in Thoracic Minimally Invasive Spine Surgery (2013–2024): A Systematic Review  \nSean Inzerillo 1,†, Chibuikem A. Ikwuegbuenyi 2,†, Eesha Gurav 3, Noah Willett 2, Mousa Hamad 2, Ibrahim Hussain 2, Alan Hernández-Hernández 4, Galal Elsayed 2, Osama Kashlan 2 and Roger Härtl 2, *  \nAcademic Editors: Panagiotis  \nG. Korovessis, Sokol Trungu and Luca Ricciardi  \nReceived: 4 November 2025  \nRevised: 12 December 2025  \nAccepted: 31 December 2025  \nPublished: 3 January 2026  \nCopyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 College of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; [sean.inzerillo@downstate.edu](sean.inzerillo@downstate.edu)  \n2 Department of Neurological Surgery, Och Spine at New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10021, USA; [cai4001@med.cornell.edu](cai4001@med.cornell.edu) (C.A.I.); [now4003@med.cornell.edu](now4003@med.cornell.edu) (N.W.); [mkh4002@med.cornell.edu](mkh4002@med.cornell.edu) (M.H.); [ibh9004@med.cornell.edu](ibh9004@med.cornell.edu) (I.H.); [sbk9015@med.cornell.edu](sbk9015@med.cornell.edu) (G.E.); [onk4001@med.cornell.edu](onk4001@med.cornell.edu) (O.K.)  \n3 School of Medicine, University of South Carolina, Columbia, SC 29208, USA; [eesha.gurav@uscmed.sc.edu](eesha.gurav@uscmed.sc.edu)  \n4 Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico; [drahh9208@gmail.com](drahh9208@gmail.com)  \n* Correspondence: [roh9005@med.cornell.edu](roh9005@med.cornell.edu)[ ](roh9005@med.cornell.edu)† These authors contributed equally to this work.  \nAbstract  \nBackground/Objectives: Thoracic minimally invasive spine surgery (MISS) offers reduced tissue trauma and faster recovery compared with open approaches, but its adoption remains limited due to technical complexity and uncertainty regarding complication rates. This study aimed to synthesize the available evidence on overall and approach-specific complications of thoracic MISS using tubular, uniportal endoscopic, and biportal endoscopic techniques. Methods: Following PRISMA guidelines (PROSPERO CRD42024594316), PubMed, Medline, Embase, and Cochrane Library were searched from January 2013 to March 2024 for studies reporting complication rates after thoracic MISS in adults. Eligible studies included tubular, uniportal, or biportal approaches. Study quality was assessed using the Newcastle–Ottawa Scale. Complication data were extracted and summarized descriptively, with reported rates stratified by surgical approach. Results: Nine studies (234 patients) were included, all retrospective with moderate risk of bias. Across included studies, reported overall complication rates following thoracic MISS ranged from 0% to 42.9% . Stratified by surgical approach, reported complication rates ranged from 0% to 11.8% across six tubular studies, 9.7% to 20.0% across two uniportal endoscopic studies, and 42.9% in a single small biportal endoscopic study. Neural injuries and dural tears were the most frequently reported complications, with reported rates ranging from 0% to 14.3% and 0% to 3.6%, respectively. Symptomatic cerebrospinal fluid leaks and revision surgeries were less common, with reported rates ranging from 0% to 11.8% and 0% to 3.2%, respectively. Conclusions: Thoracic MISS demonstrates a low overall complication rate, particularly for tubular approaches. However, findings should be interpreted with caution given the small number of included studies, retrospective designs, and clinical heterogeneity. Larger comparative investigations are needed to better define safety profilesand support broader adoption of thoracic MISS techniques.  \nKeywords: thoracic spine; minimally invasive spine surgery; tubular retractor; uniportal end","cbCaihfmaJf753MH","https://ap.wps.com/l/cbCaihfmaJf753MH","pdf",850683,12,"English","# Abstract\n## Background/Objectives\n## Methods\n## Results\n## Conclusions\n# Introduction","[{\"question\":\"What complication outcomes were evaluated in this systematic review?\",\"answer\":\"The review evaluated overall complication rates and approach-specific complications after thoracic minimally invasive spine surgery using tubular, uniportal endoscopic, and biportal endoscopic techniques.\"},{\"question\":\"How were eligible studies identified and assessed for quality?\",\"answer\":\"Databases including PubMed, Medline, Embase, and the Cochrane Library were searched from January 2013 to March 2024 for adult studies reporting complication rates. Study quality was assessed using the Newcastle–Ottawa Scale.\"},{\"question\":\"What complications occurred most often across included studies?\",\"answer\":\"Neural injuries and dural tears were the most frequently reported complications, with rates ranging from 0% to 14.3% for neural injuries and 0% to 3.6% for dural tears.\"}]","Complications in Thoracic Minimally Invasive Spine Surgery (2013–2024) - A Systematic Review | PDF",1790761750]