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Background: Despite recent treatment developments, back pain and related disabilities still represent a challenge for practitioners. Among the available surgical techniques, many different features and outcomes have been investigated; however, aesthetic result was missing among them. The present investigation was designed to prospectively compare patient-oriented aesthetic results after minimally invasive surgery (MIS) and standard open surgery (SOS) for the lumbar spine. Methods: This was a prospective observational study with 1-year follow-up. Patients who underwent SOS were assigned to group 1 and MIS to group 2. Patient-oriented aesthetic result evaluation was collected using a dedicated visual aesthetic analogue scale. The Vancouver Scar Scale was used to exclude objective underlying influencing factors. The Oswestry Disability Index and a 10-point itemized visual analogue scale for back pain were administered to assess the clinical and functional status. Follow-up data were collected before discharge at 1, 6, and 12 months. Statistical analysis was conducted, and P < 0.05 was considered as significant. Results: We enrolled 74 patients, 44 in group 1 and 30 in group 2. The 2 groups were homogeneous for demographic and clinical data. No clinical or functional differences were measured at the end of follow-up. Visual aesthetic analogue scale reported greater mean values in group 1 at every follow-up time. Conclusions: Patients seem to prefer the aesthetic result from a single midline incision after SOS compared with MIS. The use of specific techniques could be considered if there is scientific evidence reporting greater aesthetic outcome, having similar clinical and functional ones.

Background: Minimally invasive surgery (MIS) has been providing many solutions in spine surgery, and several technical variations and instrumentation systems are available. The aim of our study is to investigate the best system to perform a hybrid technique in lumbar spine fusion procedures. Methods: Sixteen patients were enrolled and randomly assigned to 1 of the 4 groups reported later. The first step in any case was midline incision, fascia exposure, and, using trocars, intravertebral transpedicle Kirschner wires (KWs) positioning through the fascia. Group definitions were A) KWs were affixed to surgical towels; B) screws with metal extensors were placed and KWs removed; C) screws with plastic extensors (K2M) were placed and those extensors were affixed to surgical towels; and D) screws without extensors or tulips (Nuvasive) were positioned. We locked the system at the end of procedure, after posterior decompression and translumbar interbody fusion cage placement. Procedures’ features were rated using properly designed questionnaires by surgeons. Results: Metal extensors were rated lower than other systems in any aspect. C and D groups’ procedures were higher rated than those in A and B in all examined fields. Furthermore, group D's procedures were reported more comfortable during facetectomy, diskectomy, and cage placement. Surgeons reported Precept Modular (Nuvasive) as the most comfortable and useful system in the hybrid technique. Conclusions: Precept Modular seems to be the most useful system when performing hybrid technique in lumbar fusion procedures. Furthermore, it results in the only one that provides the opportunity to easily and quickly switch from minimally invasive surgery to open surgery, avoiding muscles’ injuries.