Redefining Access: A Syringe-Based Tubular Retractor for Minimally Invasive Spine Surgery in Low-Resource Settings

Background: Minimally invasive spine surgery (MISS) offers superior clinical outcomes compared to traditional open techniques, particularly in reducing perioperative morbidity and promoting faster recovery. However, the high cost and limited availability of specialized instrumentation especially tubular retractors pose significant barriers in low-resource healthcare settings. This study presents an innovative, low-cost alternative using a modified 20 cc syringe as a tubular retractor in three representative MISS cases involving both degenerative and neoplastic pathologies. Methods: Three patients with diverse spinal conditions—a cervical spinal meningioma, thoracic metastatic compression, and a symptomatic lumbar facet cyst—underwent MISS using a custom-fabricated syringe retractor. The syringes were trimmed and notched to accommodate anatomical contours and secured with sterile adhesive film (Tegaderm). Surgical access was tailored to the lesion location using interlaminar or transpedicular approaches. Intraoperative stability, visualization, and ergonomics were assessed. Results: All procedures were completed successfully without intraoperative complications. The cervical tumor was excised entirely, thoracic decompression was effectively achieved with adjunct vertebroplasty, and the lumbar cyst was resected with resolution of radiculopathy. No postoperative infections, neurological deficits, or spinal instability were noted during the follow-up period. Conclusions: This case series highlights the feasibility, safety, and clinical utility of a modified syringe as a cost-effective tubular retractor in MISS. The technique offers a reproducible solution for extending advanced spinal surgical care to under-resourced settings, reinforcing the value of frugal innovation in global neurosurgery. © 2025 Elsevier B.V., All rights reserved.