Direct trans-pedicular screw fixation for atypical hangman’s fracture: A minimally invasive technique using the tubular retractor system

Microsurgical landmarks of the facet joint complex were defined to provide guidance and security within the tubular retractor during transforaminal surgery. A retrospective observational study was performed in segments L4-L5 by the left side approach. Microsurgical relevant photos, anatomical models and drawing were used to expose the suggested landmarks. The MI-TLIF technique has advantages compared with conventional open TLIF technique, however minimally invasive technique implies lack of security for the surgeon due to the lack of defined microanatomical landmarks compared to open spine surgery, and disorientation within the tubular retractor, the reason why to have precise microsurgical references and its recognition within the surgical field provide speed and safety when performing minimally invasive technique.

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MINIMALLY INVASIVE LATERAL RETROPLEURAL APPROACH TO THE THORACOLUMBAR JUNCTION – REVIEW & EXPERIENCE

Coluna/Columna ◽

10.1590/s1808-185120201904224173 ◽

2020 ◽

Vol 19 (4) ◽

pp. 236-242

Author(s):

CRISTIANO MAGALHÃES MENEZES ◽

FELIPE MIRANDA MENDONÇA FERNANDES ◽

ANDRÉ DE OLIVEIRA ARRUDA ◽

MÁRIO LEITE BRINGEL

Keyword(s):

Minimally Invasive ◽

Traditional Approach ◽

Thoracolumbar Spine ◽

Case Series ◽

Minimally Invasive Technique ◽

Thoracolumbar Junction ◽

Invasive Technique ◽

Spinal Diseases ◽

Initial Experience ◽

Tubular Retractor

ABSTRACT Objective To describe the minimally invasive technique for the lateral retropleural approach to the thoracolumbar spine and its viability in several affections of the region, demonstrating its indications, potential advantages, and necessary precautions, with an emphasis on the local anatomy, especially the diaphragm. Methods After a review of the literature, the initial experience of the Service is reported, comparing it to the published results. The surgical technique used is described with emphasis on the surgical anatomy of the diaphragm. Results The minimally invasive lateral retropleural approach to the thoracolumbar junction with the application of an expandable tubular retractor was described step-by-step in this study, with emphasis on the crucial points of technical execution, such as preoperative planning, access to the retropleural plane, and an orthogonal approach for adequate discectomy and/or corpectomy and subsequent implant placement. It can be used in the treatment of deformities, degenerative diseases, trauma, tumors, and infections and it allows for adequate interbody arthrodesis fusion rates associated with a smaller skin incision and less soft tissue damage, blood loss, and postoperative pain. Thus, it results in better postoperative mobility and a shorter hospital stay, which can also be observed in the data from initial experience of this Service. Conclusions The minimally invasive technique for the lateral retropleural approach to the thoracolumbar spine with the application of an expandable tubular retractor was shown to be promising and safe for the treatment of several spinal diseases despite the complex and challenging local anatomy and it presents advantages over the morbidity rates observed in the traditional approach. Level of evidence IV; Case series.

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Optimum Screw Configuration for the Fixation of Sanders Type IIC Tongue-Type Fractures?

Journal of the American Podiatric Medical Association ◽

10.7547/16-140 ◽

2018 ◽

Vol 108 (1) ◽

pp. 20-26

Author(s):

Tayfun Bacaksız ◽

Cemal Kazimoglu ◽

Ali Reisoglu ◽

Ali Turgut ◽

Erdem Kumtepe ◽

...

Keyword(s):

Minimally Invasive ◽

Screw Fixation ◽

Axial Loading ◽

Load Test ◽

The Other ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Calcaneal Fractures ◽

Percutaneous Screw Fixation ◽

Fracture Displacement

Background: The minimally invasive technique (percutaneous screw fixation) is one of the options for treating tongue-type IIC fractures successfully. The aim of this study was to assess the biomechanics of four different screw configurations used for the fixation of tongue-type IIC calcaneal fractures. Methods: Identical osteotomies, recapitulating a type IIC injury, were created in synthetic calcaneus specimens using a saw. The specimens were randomly assigned to one of the four fixation groups (n = 7 per group): two divergent screws, two parallel screws, two parallel screws plus one screw axially oriented toward the sustentaculum tali, and three parallel screws. A load test was performed on all of the groups, and the specimens were then tested using offset axial loading until 2, 4, and 5 mm of fracture displacement occurred. Results: Mean force values for the three–parallel screw construct at 2-, 4-, and 5-mm fracture displacements were found to be significantly higher compared with those for the other groups. Conclusions: The use of a three–parallel screw construct seems to provide more stability in the treatment of tongue-type IIC fractures.

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Minimally invasive technique for direct repair of pars interarticularis defects in adults using a percutaneous pedicle screw and hook-rod system

Journal of Neurosurgery Spine ◽

10.3171/2009.2.spine08594 ◽

2009 ◽

Vol 10 (5) ◽

pp. 492-495 ◽

Cited By ~ 22

Author(s):

Koichi Sairyo ◽

Toshinori Sakai ◽

Natsuo Yasui

Keyword(s):

Minimally Invasive ◽

Pedicle Screw ◽

Skin Incision ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Tubular Retractor ◽

Percutaneous Pedicle Screw ◽

Pars Interarticularis ◽

Rod System ◽

Sports Activities

In this report, the authors described a new minimally invasive technique to repair pars interarticularis defects in adults. The well-established technique using the pedicle screw (PS) and hook-rod system was modified. First, bilateral PSs were inserted percutaneuosly using the Sextant system. Then, through a small skin incision (3–4 cm), an illuminated tubular retractor (Quadrant system; Medtronic Sofamore Danek) was inserted into the pars defect. When this system is used, it is not necessary to detach all the back muscles to access the lytic part. The bursa and fibrocartilaginous mass near the defects were removed. After decortication of the pseudarthrosis at the spondylolytic level, bone grafts were implanted. Finally, the hook part of a hook-rod system was attached to the lamina and the rod was secured at the tulip head of the PSs. The authors performed this procedure in 2 adult patients, 32 and 24 years of age. Immediately after surgery both patients' low-back pain disappeared, and by 3 months postoperatively both had returned to their original work or sports activities.

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A minimally invasive technique for L5–S1 intraforaminal disc herniations: microdiscectomy with a tubular retractor via a contralateral approach

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/8/2/193 ◽

2008 ◽

Vol 8 (2) ◽

pp. 193-198 ◽

Cited By ~ 16

Author(s):

Jin S. Yeom ◽

Kyeong Hwan Kim ◽

Soon Woo Hong ◽

Kun-Woo Park ◽

Bong-Soon Chang ◽

...

Keyword(s):

Minimally Invasive ◽

Contralateral Side ◽

Minimally Invasive Technique ◽

Herniated Disc ◽

Invasive Technique ◽

Neural Foramen ◽

Tubular Retractor ◽

Stabilization Procedure ◽

Disc Herniations ◽

Operative Microscope

✓ Surgical treatment of intraforaminal disc herniations at the L5–S1 level is technically demanding. The 2 most commonly used procedures involve either a medial or lateral ipsilateral approach and often require a partial or even complete facet resection, which may in turn result in vertebral instability and/or back pain, as well as, in some cases, a fusion or stabilization procedure. In this report, the authors present a new minimally invasive technique for the treatment of L5–S1 intraforaminal disc herniations. Using this technique, which involves tubular retractors and an operative microscope to approach the neural foramen from the contralateral side, the authors could easily visualize and remove the herniated disc material and perform a thorough microdiscectomy with minimal resection of osseous and ligamentous structures. To illustrate this new minimally invasive technique for the treatment of intraforaminal disc herniations at L5–S1, they describe the cases of 2 patients who underwent the procedure and in whom successful results were achieved.

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Use of a Tubular Retractor System as a Minimally Invasive Technique for Epidural Plate Electrode Placement under Local Anesthesia for Spinal Cord Stimulation: Technical Note

Operative Neurosurgery ◽

10.1227/01.neu.0000193536.06577.d1 ◽

2006 ◽

Vol 58 ◽

pp. ONS-E177 ◽

Cited By ~ 2

Author(s):

Tjemme Beems ◽

Robert T.M. van Dongen

Keyword(s):

Spinal Cord ◽

Minimally Invasive ◽

Local Anesthesia ◽

Spinal Cord Stimulation ◽

Technical Note ◽

Minimally Invasive Technique ◽

Electrode Placement ◽

Invasive Technique ◽

Tubular Retractor ◽

Plate Electrode

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Minimally invasive percutaneous screw fixation of traumatic spondylolisthesis of the axis

Journal of Neurosurgery Spine ◽

10.3171/2014.10.spine131168 ◽

2015 ◽

Vol 22 (5) ◽

pp. 459-465 ◽

Cited By ~ 16

Author(s):

Avery Lee Buchholz ◽

Steven L. Morgan ◽

Leslie C. Robinson ◽

Bruce M. Frankel

Keyword(s):

Minimally Invasive ◽

Screw Fixation ◽

Dynamic Imaging ◽

Cervical Collar ◽

Type I ◽

Type Ii ◽

Percutaneous Screw Fixation ◽

Hangman’S Fracture ◽

Hangman's Fracture ◽

Traumatic Spondylolisthesis

OBJECT Most cases of traumatic spondylolisthesis of the axis (hangman's fracture) can be treated nonoperatively with reduction and subsequent immobilization in a rigid cervical collar or halo. However, in some instances, operative management is necessary and can be accomplished by using either anterior or posterior fusion techniques. Because open posterior procedures can result in significant blood loss, pain, and limited cervical range of motion, other less invasive options for posterior fixation are needed. The authors describe a minimally invasive, navigation-guided technique for surgical treatment of Levine-Edwards (L-E) Type II hangman's fractures. METHODS For 5 patients with L-E Type II hangman's fracture requiring operative reduction and internal fixation, percutaneous screw fixation directed through the fracture site was performed. This technique was facilitated by use of intraoperative 3D fluoroscopy and neuronavigation. RESULTS Of the 5 patients, 2 were women, 3 were men, and age range was 46–67 years. No intraoperative or postoperative complications occurred. All patients wore a rigid cervical collar, and flexion-extension radiographs were obtained at 6 months. For all patients, dynamic imaging demonstrated a stable construct. CONCLUSIONS L-E type II hangman's fractures can be safely repaired by using percutaneous minimally invasive surgical techniques. This technique may be appropriate, depending on circumstances, for all L-E Type I and II hangman's fractures; however, the degree of associated ligament injury and disc disruption must be accounted for. Percutaneous fixation is not appropriate for L-E Type III fractures because of significant displacement and ligament and disc disruption. This report is meant to serve as a feasibility study and is not meant to show superiority of this procedure over other surgical options.

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