Minimally Invasive Surgery (Keyhole Surgery)

Keyhole surgery means doing the same operation through a much smaller opening. For many lumbar problems, this means less muscle damage and a quicker return to walking. It is not right for everyone, and your surgeon will tell you honestly whether it suits you.

Reviewed by Dr. Kshitij Chaudhary. Last reviewed October 2026

What is keyhole surgery?

In open surgery, the surgeon cuts and lifts the back muscles away from the spine to see the problem. In keyhole surgery, also known as Minimally Invasive Tubular Retraction (MITR), a small cut is made and a narrow tube is passed through the muscle. The surgeon works through this tube. The same problem gets fixed, but the muscles are gently pushed aside rather than cut and stripped off the bone.

Which problems can be treated this way?

We use the tubular approach for these lumbar problems:

• Lumbar canal stenosis, where the spinal canal is too narrow and squeezes the nerves
• Foraminal stenosis, where the exit tunnel for a nerve is narrowed
• Disc herniations, where a slipped disc presses on a nerve
• Synovial cysts, fluid-filled sacs from a worn joint that press on a nerve
• Spondylolisthesis, where one vertebra slips forward over the one below

Which operations are done this way?

Each one has its own page, with the full details:

• Tubular microdiscectomy for a slipped disc. See Microdiscectomy (Slipped Disc Surgery)
• Tubular lumbar decompression for canal stenosis, foraminal stenosis and synovial cysts. See Laminectomy
• MIS TLIF for spondylolisthesis. See TLIF

What are the benefits?

The muscles are disturbed less, so there is usually less pain after surgery and an earlier return to walking. Most patients are up and walking on the day of surgery. After a decompression or microdiscectomy, you usually go home the same day or the next day. After a fusion (MIS TLIF), you usually walk within a day and stay in hospital for 2 to 3 days.

Is keyhole surgery always better?

No. It is a different route to the same goal, not a better operation by default. Some problems are sometimes better treated with open surgery, for example:

• A high-grade spondylolisthesis, where the slip is large
• Disease at several levels of the spine
• Revision surgery, where you have had an operation before and there is scar tissue

The best choice depends on your scan, your symptoms and your general health. If keyhole surgery is not suitable for you, I will tell you why.

Do I need surgery at all?

Many back and leg problems settle with time, medicines, physiotherapy or injections. Surgery is for those who do not improve, or who have nerve weakness that is getting worse. Read more in Do I Actually Need Surgery?

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About Dr. Kshitij Chaudhary

This page was written by Dr. Kshitij Chaudhary, a fellowship-trained spine surgeon at P.D. Hinduja Hospital, Mumbai, trained in complex spine surgery at Harvard Medical School (Beth Israel Deaconess) and the Twin Cities Spine Center, Minneapolis. ⚕️About Dr. Chaudhary