What is Less Exposure Spine Surgery? A Beginner’s Guide

Written by Sukanya Chebrolu, MS and Chukwunonso C. Ilogu, MD, MS of the LESS™ Society.

Spinal health remains a significant concern for many adults, but recent advances in medical technology have transformed how we approach treatment. One of the most groundbreaking innovations is Less Exposure Spine Surgery (LESS™), a surgical philosophy that emphasizes safety, efficiency, and the preservation of healthy tissue over traditional techniques. While both LESS™ and conventional minimally invasive spine (MIS) surgery use fluoroscopy for guidance, their approaches differ fundamentally. MIS often aims to replicate the outcomes of open surgery through smaller incisions, using tubes, retractors, or endoscopes to access the spine percutaneously. Despite these smaller incisions, MIS can still cause substantial collateral damage, including the removal or disruption of normal tissue.

In contrast, the LESS ™ approach also uses small incisions but differs fundamentally in intent and execution. The LESS™ Institute is at the forefront of this advancement, pioneering innovative techniques that improve spinal outcomes and enhance quality of life.

What is the LESS™ Philosophy?

Traditional open spine surgeries require large incisions, significant muscle dissection, and extended hospital stays. In contrast, LESS™ utilizes targeted exposure and specialized instruments to treat spinal conditions while preserving healthy tissues. This approach is built on the core R.E.P™ principles of the LESS™ philosophy which includes:

1.) Restore Function: LESS™ restores the spine’s natural alignment and biomechanics to help patients regain mobility and stability. It also helps patients return to their daily activities with greater ease.

2.) Early intervention: Identifying and treating spinal conditions early helps patients avoid invasive surgeries and prolonged recovery periods. LESS™ techniques allow for proactive care, improving long-term outcomes.

3.) Preserve Anatomy: LESS™ prioritizes preserving healthy tissues, minimizing disruption to surrounding structures. This reduces complications and supports long-term spinal health.

 This method offers several key benefits:

• LESS  Postoperative Pain: Smaller incisions and less tissue manipulation lead to decreased pain after surgery.

• LESS  Hospital Stays: Many MISS procedures are performed on an outpatient basis, allowing patients to return home the same day (1).

• LESS  Recovery: Patients often resume daily activities much sooner than with traditional surgery.

• LESS Infection Risk: Reduced exposure lowers the likelihood of postoperative infections (2,3).

Conditions Treated with LESS™ 

LESS™ is highly effective for treating many spinal conditions, including:

• Herniated or bulging discs.

• Spinal stenosis (narrowing of the spinal canal).

• Degenerative disc disease (DDD).

• Vertebral fractures.

• Spinal instability (e.g., spondylolisthesis), and more.

Your surgeon will evaluate your condition, imaging results, and overall health to determine if LESS™ is the right option for you.

How Does LESS™ Differ from Traditional Spine Surgery?

 

Traditional open spine surgery requires large incisions to expose the spine, which can damage surrounding muscles and tissues, often leading to longer recovery times and increased post-operative pain. LESS™, on the other hand, follows a refined approach that minimizes collateral damage. Here’s a quick comparison of key factors:

Factor	LESS™	Traditional Surgery
Incision Size	1-2 inches	4-6 inches
Muscle Damage	Minimal	Significant
Hospital Stay	Outpatient or 1-2 days	3-5 days
Recovery Time	Weeks	Months
Scarring	Tiny, barely visible	Larger, more visible

The LESS™ Institute’s Unique Approach

Expanding on the principles of targeted exposure, the LESS™ Institute has developed a specialized approach that enhances the benefits traditional methods while addressing their limitations. The LESS™ treatment emphasizes:

• Targeted Treatment: Only the affected area is exposed, preserving healthy tissues and structures.

• Advanced Technology: Cutting-edge tools and techniques maximize effectiveness while minimizing impact.

• Reduced Radiation Exposure: Unlike some MISS methods that heavily rely on fluoroscopy (continuous x-ray), LESS™  techniques prioritize minimizing radiation for enhanced patient safety (4).

• A Holistic Approach to Spine Care: The LESS™ approach is not just about surgery but also about preoperative planning, postoperative rehabilitation, and long-term spine health.

  
  

By following the principle of KISS: Keep It Simple, Safe, and Sensible, the LESS™ Institute provides a more secure and effective surgical experience for patients (5,6).

See the Difference: LESS™ vs. MISS vs. Open Surgery

The image below compares incision sizes and scarring from three spine surgery techniques. LESS™  has the smallest incisions with minimal scarring, while open surgery requires the largest incision, leading to more noticeable scars and longer recovery.

Description: Comparison of spinal surgeries highlighting incision size: the invasive open procedure, the less invasive MIS Procedure, and the minimal incision <1 inch LESS™ procedure.

Image Source: https://www.thelessinstitute.com/about-less-exposure-spine-surgery 

Take the Next Step Toward a Pain-Free Life

If you’re considering spine surgery, explore the advantages of LESS™ procedures at the LESS™  Institute. Determine your eligibility for these innovative techniques by scheduling a consultation. Take the first step towards enhanced mobility and pain relief today and please visit the LESS™  Institute to book an appointment today!

Learn More About LESS™ 

Spine surgery is moving beyond traditional methods toward safer, less invasive solutions. LESS™  technology is leading this shift to outpatient, tissue-sparing care that improves outcomes and speeds recovery.

Check out this LinkedIn post from KIC Ventures to learn how LESS™ is shaping the future of spine surgery:https://www.linkedin.com/feed/update/urn:li:activity:7318641379197243393.

Frequently Asked Questions (FAQs)

1. How long does Less Exposure Spine Surgery (LESS™) take?

• Most procedures take 1-3 hours, depending on complexity.

  
  

2. Will I need general anesthesia?

• Yes, some procedures use local anesthesia with sedation.

  
  

3. Does insurance cover LESS™?

• Most plans do, but coverage varies.

References

1. Boadi, B. I., Ikwuegbuenyi, C. A., Inzerillo, S., Dykhouse, G., Bratescu, R., Omer, M., Kashlan, O. N., Elsayed, G., & Härtl, R. (2024). Complications in minimally invasive spine surgery in the last 10 years: A narrative review. Neurospine, 21(3), 770–803. https://doi.org/10.14245/ns.2448652.326 

2. Oppenheimer, J. H., DeCastro, I., & McDonnell, D. E. (2009). Minimally invasive spine technology and minimally invasive spine surgery: A historical review. Neurosurgical Focus, 27(3), E9. https://doi.org/10.3171/2009.7.FOCUS09121 

3. Chin, K. R., & Michener, T. A. (2006). Prospective evaluation of a 3-blade speculum cannula for minimally invasive lumbar microdiscectomy. Journal of Spinal Disorders & Techniques, 19(4), 257–261. https://doi.org/10.1097/01.bsd.0000203272.12875.e4 

4. Smith, Z. A., & Fessler, R. G. (2012). Paradigm changes in spine surgery: Evolution of minimally invasive techniques. Nature Reviews Neurology, 8(8), 443–450. https://doi.org/10.1038/nrneurol.2012.110 

5. The LESS Institute. (2025). About Less Exposure Spine Surgery. Retrieved from https://www.thelessinstitute.com/about-less-exposure-spine-surgery 

6. KIC Ventures. (2025). LESS Philosophy. Retrieved from https://www.kicventures.com/less-philosophy