Minimally invasive spine surgery in socioeconomically disadvantaged populations—a narrative review

Background and Objective: Minimally invasive spine surgery (MISS) offers favorable intraoperative benefits and comparable postoperative outcomes to open spine surgery. However, while these benefits are established in general populations, less is known regarding MISS in socioeconomically disadvantaged populations. Applying a Social Determinants of Health (SDoH) framework enables a structured evaluation of how socioeconomic disadvantage affects access to and outcomes of MISS. Our aim was to explore and synthesize current literature, identify gaps, and outline future directions for MISS in socioeconomically disadvantaged populations. Methods: Five dimensions of SDoH—race, insurance status, economic status, education, and geography—within open and MISS were explored. A literature review using PubMed, Embase, and Google Scholar identified peer-reviewed studies, meta-analyses, systematic reviews, and retrospective studies published between June 1994 and May 2025 in any language. Articles were assessed for relevancy, and a manual review of bibliographies of applicable articles was conducted to find additional relevant articles. Articles were excluded if they failed to address any of the above categories of SDoH and spine surgery. Additional queries were done to provide adequate background context within the realm of social determinants of health on outcomes of spinal surgery. Key Content and Findings: Across all SDoH domains, there is substantial literature demonstrating their influence on access to care and outcomes in spine surgery. Socioeconomically disadvantaged patients consistently face barriers to surgical access and experience worse outcomes. However, research specific to MISS in these domains remains limited. Emerging research suggests that while socioeconomically disadvantaged patients may derive similar postoperative benefits, economic and insurance-related barriers may limit access and de-incentivize MISS utilization. Conclusions: SDoH influences approaches to healthcare and highlights disparities in disadvantaged populations, however MISS remains understudied in this area. Nonetheless, patients with deficits in SDoH domains risk decreased access to and poorer outcomes from MISS. The increasing prevalence of MISS warrants a similar increase in the body of literature examining how patients from disadvantaged backgrounds might benefit. Future studies might employ validated social deprivation metrics and approach-specific analysis to better analyze MISS in this population to generate targeted, system-level changes to promote equitable access and outcomes.