92 Minimally invasive proceduresposterior deformity correction inMinimally Invasive Posterior Deformity Correction Techniques

Category: Bunion Introduction/Purpose: Minimally invasive surgery for hallux valgus has significantly increased in popularity recently due to smaller incisions, reduced soft tissue trauma, and the ability to achieve large deformity corrections compared to traditional treatments. This study aimed to investigate the radiological outcomes and degree of deformity correction of the intermetatarsal angle (IMA) and the hallux valgus angle (HVA) following third generation (using screw fixation) Minimally Invasive Chevron and Akin Osteotomies (MICA) for hallux valgus. Methods: A single surgeon case series of patients with hallux valgus underwent primary, third generation MICA for hallux valgus. Pre- and post-operative (6 weeks after surgery) radiological assessments of the IMA and HVA were based on weight-bearing dorso-plantar radiographs. Radiographic measurements were conducted by two foot & ankle fellowship trained consultant surgeons (RR, DG). Paired t-tests were used to determine the statistically significant difference between pre- and post-operative measurements. Results: Between January 2017 and December 2019, 401 MICAs were performed in 274 patients. Pre- and post-operative radiograph measurements were collected for 348 feet in 232 patients (219 female; 13 male). The mean age was 54.4 years (range 16.3-84.9, standard deviation (s.d.) 13.2). Mean pre-operative IMA was 15.3° (range 6.5°-27.0°, s.d. 3.4°) and HVA was 33.8° (range 9.3°-63.9°, s.d. 9.7°). Post-operatively, there was a statistically significant improvement in radiological deformity correction; mean IMA was 5.3° (range -1.2°-16.5°, s.d. 2.7°, p<0.001) and mean HVA was 8.8° (range -5.2°-24.0°, s.d. 4.5°, p<0.001). The mean post-operative reduction in IMA and HVA was 10.0° and 25.0° respectively. Conclusion: This is the largest case series demonstrating radiological outcomes following third generation Minimally Invasive Chevron and Akin Osteotomies (MICA) for hallux valgus to date. These data show that this is an effective approach at correcting both mild and severe hallux valgus deformities. Longer term radiological outcome studies are needed to investigate whether there is any change in radiological outcomes. Correlation with patient reported outcomes is planned.

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Minimally invasive L5–S1 oblique lumbar interbody fusion with anterior plate

Neurosurgical FOCUS ◽

10.3171/2016.2.focusvid.1692 ◽

2016 ◽

Vol 41 (videosuppl1) ◽

pp. 1

Author(s):

Martin H. Pham ◽

Andre M. Jakoi ◽

Patrick C. Hsieh

Keyword(s):

Minimally Invasive ◽

Degenerative Disc Disease ◽

Interbody Fusion ◽

Deformity Correction ◽

Lumbar Interbody Fusion ◽

Degenerative Scoliosis ◽

Anterior Plate ◽

Disc Disease ◽

Case Presentation ◽

Oblique Lumbar Interbody Fusion

Lumbar interbody fusion is an important technique for the treatment of degenerative disc disease and degenerative scoliosis. The oblique lumbar interbody fusion (OLIF) establishes a minimally invasive retroperitoneal exposure anterior to the psoas and lumbar plexus. In this video case presentation, the authors demonstrate the techniques of the OLIF at L5–S1 performed on a 69-year-old female with degenerative scoliosis as one component of an overall strategy for her deformity correction.The video can be found here: https://youtu.be/VMUYWKLAl0g.

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A Critical Analysis of Sagittal Plane Deformity Correction with Minimally Invasive Adult Spinal Deformity Surgery: A Two-Year Follow-Up Study

The Spine Journal ◽

10.1016/j.spinee.2015.07.113 ◽

2015 ◽

Vol 15 (10) ◽

pp. S126-S127

Author(s):

International Spine Study Group ◽

Gregory M. Mundis ◽

Jay D. Turner ◽

Vedat Deviren ◽

Juan S. Uribe ◽

...

Keyword(s):

Minimally Invasive ◽

Spinal Deformity ◽

Critical Analysis ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Follow Up Study ◽

Spinal Deformity Surgery ◽

Plane Deformity

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Minimally invasive spinal surgery: a historical perspective

Neurosurgical FOCUS ◽

10.3171/foc.2004.16.1.14 ◽

2004 ◽

Vol 16 (1) ◽

pp. 1-10 ◽

Cited By ~ 57

Author(s):

Issada Thongtrangan ◽

Hoang Le ◽

Jon Park ◽

Daniel H. Kim

Keyword(s):

Minimally Invasive ◽

Spinal Surgery ◽

Lumbar Disc ◽

Deformity Correction ◽

Transoral Surgery ◽

Invasive Treatment ◽

Disc Disease ◽

Lumbar Disc Disease ◽

Minimally Invasive Spinal Surgery ◽

Neurogenic Tumors

The concept of minimally invasive spinal surgery embodies the goal of achieving clinical outcomes comparable to those of conventional open surgery, while minimizing the risk of iatrogenic injury that may be incurred during the exposure process. The development of microscopy, laser technology, endoscopy, and video and image guidance systems provided the foundation on which minimally invasive spinal surgery is based. Minimally invasive treatments have been undertaken in all areas of the spinal axis since the 20th century. Lumbar disc disease has been treated using chemonucleolysis, percutaneous discectomy, laser discectomy, intradiscal thermoablation, and minimally invasive microdiscectomy techniques. The initial use of thoracoscopy for thoracic discs and tumor biopsies has expanded to include deformity correction, sympathectomy, vertebrectomy with reconstruction and instrumentation, and resection of paraspinal neurogenic tumors. Laparoscopic techniques, such as those used for appendectomy or cholecystectomy by general surgeons, have evolved into procedures performed by spinal surgeons for anterior lumbar discectomy and fusion. Image-guided systems have been adapted to facilitate pedicle screw placement with increased accuracy. Over the past decade, minimally invasive treatment of cervical spinal disorders has become feasible by applying technologies similar to those developed for the thoracic and lumbar spine. Endoscope-assisted transoral surgery, cervical lam-inectomy, discectomy, and foraminotomy all represent the continual evolution of minimally invasive spinal surgery. Further improvement in optics and imaging resources, development of biological agents, and introduction of instrumentation systems designed for minimally invasive procedures will inevitably lead to further applications in minimally invasive spine surgery.

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Anterior Longitudinal Ligament Release From the Minimally Invasive Lateral Retroperitoneal Transpsoas Approach: Technical Note

Operative Neurosurgery ◽

10.1227/neu.0000000000001203 ◽

2016 ◽

Vol 12 (3) ◽

pp. 214-221 ◽

Cited By ~ 5

Author(s):

Joshua M Beckman ◽

Nicola Marengo ◽

Gisela Murray ◽

Konrad Bach ◽

Juan S Uribe

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Lumbar Lordosis ◽

Adult Spinal Deformity ◽

Vascular Complications ◽

Deformity Correction ◽

Anterior Longitudinal Ligament ◽

Global Improvement ◽

Transpsoas Approach ◽

Indirect Decompression

Abstract BACKGROUND The technique for minimally invasive anterior longitudinal ligament release is a major advancement in lateral access surgery. This method provides hypermobility of lumbar segments to allow for aggressive lordosis restoration while maintaining the benefits of indirect decompression and minimally invasive access. OBJECTIVE To provide video demonstration of the lateral retroperitoneal transpsoas approach with anterior longitudinal ligament sectioning. METHODS A detailed surgical technique of the minimally invasive anterior column release is described and illustrated in an elderly patient with adult spinal deformity and low back pain (visual analog scale, 8 of 10) refractory to conservative measures. The 3-foot standing radiographs demonstrated a lumbar lordosis of 54.4°, pelvic incidence of 63.7°, and pelvic tilt of 17.5°. Computed tomography and magnetic resonance imaging showed generalized lumbar spondylosis and degenerative disc changes from L2 to L5. RESULTS The patient underwent a multilevel minimally invasive deformity correction with an anterior longitudinal ligament release at the L3/L4 level through the lateral retroperitoneal transpsoas approach. Lumbar lordosis increased from 54.4° to 77° with a global improvement in sagittal vertical axis from 4.37 cm to 0 cm. Total blood loss was less than 25 mL, and there were no major neurological or vascular complications. CONCLUSION The anterior longitudinal ligament release using the minimally invasive lateral approach allows for deformity correction without the morbidity and blood loss encountered by traditional open posterior approaches. However, the risk of major vascular/visceral complication warrants only experts in minimally invasive lateral surgery to attempt this technique.

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Adult Deformity Correction Through Minimally Invasive Lateral Approach Techniques

Spine ◽

10.1097/brs.0b013e318202495f ◽

2010 ◽

Vol 35 (Supplement) ◽

pp. S312-S321 ◽

Cited By ~ 68

Author(s):

Gregory M. Mundis ◽

Behrooz A. Akbarnia ◽

Frank M. Phillips

Keyword(s):

Minimally Invasive ◽

Deformity Correction ◽

Lateral Approach ◽

Adult Deformity

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Minimally invasive correction of asymmetric chest deformity in children

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2021-25-1-44-50 ◽

2021 ◽

Vol 25 (1) ◽

pp. 44-50

Author(s):

A.A.I. El'nour ◽

A. Yu. Razumovskiy

Keyword(s):

Surgical Treatment ◽

Minimally Invasive ◽

Chest Wall ◽

Deformity Correction ◽

Length Of Hospital Stay ◽

Surgical Correction ◽

Chest Wall Deformity ◽

Rehabilitation Process ◽

Chest Deformity

Purpose. To analyze literature data and to find out optimal techniques for surgical correction of asymmetrical chest wall deformity in children.Material and methods. The researchers studied data on surgical treatment of children with asymmetrical chest wall deformity who had thoracoplasty performed with well-known techniques developed by Bairov, Timoshchenko, Paltia, Ravitch, Kondrashin which included the resection of crooked cartilage and internal metal fixation with consideration of deformity shape, location and severity. For comparison, the authors analyzed the data on the minimally invasive Nuss technique and its modifications.Results. The researchers found that thoracoplasty by the Bairov method is less effective which gives the largest number of postoperative complications (16.5%) in the form of hemothorax, pneumothorax and hydrothorax what significantly increased the length of hospital stay and the following rehabilitation process. On the contrary, minimally invasive interventions were the most effective, if to compare with all applied techniques for chest wall deformity correction, having a low percentage of complications; though their drawback is long-term postoperative analgesia.Conclusion. At present, there is no any consensus on the top-priority technique for surgical correction of chest wall deformity in children. It necessitates further research in this direction as well as improvement of the existing techniques and development of new ones.

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Minimally invasive scoliosis surgery assisted by O-arm navigation for Lenke Type 5C adolescent idiopathic scoliosis: a comparison with standard open approach spinal instrumentation

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.11.peds16412 ◽

2017 ◽

Vol 19 (4) ◽

pp. 472-478 ◽

Cited By ~ 18

Author(s):

Weiguo Zhu ◽

Weixiang Sun ◽

Leilei Xu ◽

Xu Sun ◽

Zhen Liu ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Minimally Invasive ◽

Idiopathic Scoliosis ◽

Spinal Instrumentation ◽

Deformity Correction ◽

Scoliosis Surgery ◽

Open Approach ◽

Additional Surgery ◽

Estimated Blood Loss

OBJECTIVE Recently, minimally invasive scoliosis surgery (MISS) was introduced for the correction of adult scoliosis. Multiple benefits including a good deformity correction rate and fewer complications have been demonstrated. However, few studies have reported on the use of MISS for the management of adolescent idiopathic scoliosis (AIS). The purpose of this study was to investigate the outcome of posterior MISS assisted by O-arm navigation for the correction of Lenke Type 5C AIS. METHODS The authors searched a database for all patients with AIS who had been treated with either MISS or PSF between November 2012 and January 2014. Levels of fusion, density of implants, operation time, and estimated blood loss (EBL) were recorded. Coronal and sagittal parameters were evaluated before surgery, immediately after surgery, and at the last follow-up. The accuracy of pedicle screw placement was assessed according to postoperative axial CT images in both groups. The 22-item Scoliosis Research Society questionnaire (SRS-22) results and complications were collected during follow-up. RESULTS The authors retrospectively reviewed the records of 45 patients with Lenke Type 5C AIS, 15 who underwent posterior MISS under O-arm navigation and 30 who underwent posterior spinal fusion (PSF). The 2 treatment groups were matched in terms of baseline characteristics. Comparison of radiographic parameters revealed no obvious difference between the 2 groups immediately after surgery or at the final follow-up; however, the MISS patients had significantly less EBL (p < 0.001) and longer operation times (p = 0.002). The evaluation of pain and self-image using the SRS-22 showed significantly higher scores in the MISS group (p = 0.013 and 0.046, respectively) than in the PSF group. Postoperative CT showed high accuracy in pedicle placement in both groups. No deep wound infection, pseudarthrosis, additional surgery, implant failure, or neurological complications were recorded in either group. CONCLUSIONS Minimally invasive scoliosis surgery is an effective and safe alternative to open surgery for patients with Lenke Type 5C AIS. Compared with results of the open approach, the outcomes of MISS are promising, with reduced morbidity. Before the routine use of MISS, however, long-term data are needed.

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Minimally invasive deformity correction: surgical technique

Neurosurgical FOCUS ◽

10.3171/2013.v2.focus13189 ◽

2013 ◽

Vol 35 (v2supplement) ◽

pp. Video3

Author(s):

Kevin S. Chen ◽

Khoi D. Than ◽

Frank LaMarca ◽

Paul Park

Keyword(s):

Minimally Invasive ◽

Lumbar Lordosis ◽

Pelvic Incidence ◽

Deformity Correction ◽

Pedicle Screw Placement ◽

Invasive Treatment ◽

Tubular Retractor ◽

Coronal Balance ◽

Percutaneous Pedicle Screw ◽

Key Steps

This video details a minimally invasive treatment of symptomatic adult kyphoscoliosis. Both anterior and posterior approaches are used to obtain sagittal and coronal balance. In addition, improved lumbar lordosis is achieved to closely match the patient's pelvic incidence. The key steps for the lateral transpsoas procedure are detailed in the first portion of the video and include positioning, fluoroscopic localization, exposure with tubular retractor placement, interbody preparation and grafting, and closure. The second portion of the video shows positioning, fluoroscopic positioning/guidance, exposure for percutaneous pedicle screw placement, rod insertion, and closure.The video can be found here: http://youtu.be/cHkTMtSXZ8A.

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