Minimally Invasive Navigated Foraminal Discectomy via Contralateral Approach Using a 3-Dimensional 4K High-Definition Exoscope: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E188-E188
Author(s):  
Jonathan Oren ◽  
Kevin Kwan ◽  
Julia Schneider ◽  
Mitchell Levine ◽  
David Langer
Keyword(s):  
Informed Consent ◽  
Minimally Invasive ◽  
Invasive Technique ◽  
High Definition ◽  
High Quality ◽  
Tubular Retractor ◽  
3 Dimensional ◽  
Intraoperative Fluoroscopy ◽  
Disc Herniations ◽  
Operative Microscope

Abstract This surgical video is the first to demonstrate a novel minimally invasive technique of utilization of surgically navigated foraminal discectomy using a 3-dimensional 4k high-definition exoscope (Sony Olympus). Typical approaches for foraminal disc herniations may involve violation of the facet resulting in subsequent destabilization requiring fusion.1 Although minimally invasive facet-sparing contralateral techniques have previously been described,2 there is continued limitations stemming from rudimentary localization with standard fluoroscopy and impaired visualization with the bulky traditional operative microscope.3 We demonstrate that high-quality real-time navigation is possible using standard Iso-C intraoperative fluoroscopy for 3-dimensional reconstructions, allowing for intraoperative routing. Navigation is particularly advantageous for adjustments in the trajectory of the tubular retractor and for confirmation of complete foraminal decompression. Visualization from the 4k high-definition exoscope also allows for an unparalleled view of the narrow operative corridor and allows for participation from the operative team. Informed consent was obtained from the patient for the surgery in its entirety.

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

2008 ◽  
Vol 8 (2) ◽  
pp. 193-198 ◽  
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.

MINIMALLY INVASIVE LUMBAR DISCECTOMY IN OBESE PATIENTS

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. 539-544 ◽  
Author(s):  
John S. Cole ◽  
Thad R. Jackson
Keyword(s):  
Minimally Invasive ◽  
Patient Outcomes ◽  
Patient Population ◽  
Chart Review ◽  
Infectious Complications ◽  
Invasive Technique ◽  
Complication Rates ◽  
Incision Length ◽  
Disc Herniations ◽  
Near Future

Abstract OBJECTIVE To assess patient outcomes and complication rates after minimally invasive lumbar microdiscectomy in an obese patient population. METHODS A retrospective clinical review of 32 patients with a body mass index of 30 kg/m2 or greater undergoing lumbar minimally invasive discectomy was performed. The initial chart review was followed by phone interview if all information could not be obtained from chart review. Demographic and pertinent pre-, peri-, and postoperative data were obtained. RESULTS Favorable clinical outcomes were obtained in all patients except one, indicating that they would undergo operative intervention again. Most patients reported minimal or no leg or back pain. Twenty-five of the patients did not require any chronic analgesia. The overall complication rate was 12.5%. Two patients had recurrent disc herniations requiring reoperation and one patient required fusion for a pars defect and subsequent subluxation. CONCLUSION Lumbar minimally invasive discectomy is our preferred surgical technique for symptomatic disc herniations in this patient population. Decreased incision length and a trend toward reduced infectious complications are the primary reasons. We feel that, given the comorbidities often found in this patient population, a minimally invasive technique will supplant open approaches in the near future.

scholarly journals Minimally invasive approach to extraforaminal disc herniations at the lumbosacral junction using an operating microscope: case series and review of the literature

2008 ◽  
Vol 25 (2) ◽  
pp. E10 ◽  
Author(s):  
Stephen M. Pirris ◽  
Sanjay Dhall ◽  
Praveen V. Mummaneni ◽  
Adam S. Kanter
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc ◽  
Case Series ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Surgical Access ◽  
Small Series ◽  
Disc Herniations ◽  
Anatomical Constraints

Surgical access to extraforaminal lumbar disc herniations is complicated due to the unique anatomical constraints of the region. Minimizing complications during microdiscectomies at the level of L5–S1 in particular remains a challenge. The authors report on a small series of patients and provide a video presentation of a minimally invasive approach to L5–S1 extraforaminal lumbar disc herniations utilizing a tubular retractor with microscopic visualization.

scholarly journals Minimizing cortical disturbance to access ventricular subependymoma – A novel approach utilizing spinal minimally invasive tubular retractor system

2019 ◽  
Vol 10 ◽  
pp. 95
Author(s):  
Eric Klotz ◽  
Wendy Towers ◽  
Khalid Kurtom
Keyword(s):  
Minimally Invasive ◽  
Lateral Ventricle ◽  
Obstructive Hydrocephalus ◽  
Invasive Technique ◽  
Benign Tumors ◽  
En Bloc ◽  
Tubular Retractor ◽  
Excellent Outcome ◽  
Left Lateral Ventricle ◽  
Tubular System

Background: Subependymomas are rare benign tumors found primarily in the lateral and fourth ventricles. Patients become symptomatic when the tumor obstructs cerebrospinal fluid pathways. We present a novel minimally invasive technique for lateral ventricular subependymoma resection. Case Description: A 57-year-old male presented after a period of progressive ataxia, right upper extremity tremor, and syncopal events. Emergent non-contrast computed tomography of the brain demonstrated a lobulated mass in the left lateral ventricle causing moderate-to-severe obstructive hydrocephalus. Emergent ventriculostomy was placed as a temporizing measure. Subsequent magnetic resonance imaging (MRI) illustrated a large benign appearing mass causing obstruction of the left foramen of Monroe. A small craniotomy was performed utilizing previous ventriculostomy twist hole. The left lateral ventricle was accessed through sequential dilation of ventriculostomy tract using a minimally invasive spine surgery tubular system. Tumor was resected en bloc under microscopic assistance. The patient had an excellent outcome with return to baseline mental status and was discharged from the hospital postoperative day 1. Follow-up MRI demonstrated gross total resection of the mass and decreasing lateral ventricle hydrocephalus with minimal cortical disturbance. Conclusion: A minimally invasive tubular system approach to ventricular tumors can be utilized to minimize cortical resection and brain retraction. Minimally invasive surgery also has the potential to decrease the length of stay and enhance postoperative recovery.

Type I Spinal Dural Fistula Treated Using a Minimally Invasive Approach With a 20-mm Nonexpandable Tubular Retractor: 3-Dimensional Operative Video

2018 ◽  
Vol 15 (5) ◽  
pp. E52-E52
Author(s):  
Krunal Patel ◽  
Jason McMillen ◽  
Ramez W Kirollos ◽  
Karol P Budohoski ◽  
Thomas Santarius ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Type I ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
3 Dimensional ◽  
Dural Fistula

scholarly journals Percutaneous ozone nucleolysis for lumbar disc herniation

2018 ◽  
Vol 60 (11) ◽  
pp. 1231-1241 ◽  
Author(s):  
Mohamed Ezeldin ◽  
Marco Leonardi ◽  
Ciro Princiotta ◽  
Massimo Dall’olio ◽  
Mohammed Tharwat ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pain Intensity ◽  
Lumbar Disc ◽  
Cost Effective ◽  
Invasive Technique ◽  
Pain Disability ◽  
Chi Squared ◽  
Disc Herniations ◽  
The Mean ◽  
Initial Results

Abstract Purpose All percutaneous minimally invasive disc treatments are typically indicated to contained disc herniations. Our study’s aim is to evaluate prospectively the efficacy of ozone nucleolysis in the treatment of either contained or uncontained lumbar disc herniations. Methods Fifty-two patients, aged 27–87 years, with symptomatic herniated lumbar discs, without migration, sequestration, or severe degenerative disc changes, who failed conservative treatment, were included in our study. The patients underwent fluoroscopic-guided intradiscal oxygen-ozone mixture injection (5 ml) at a concentration of 27–30 μg/ml and periradicular injection of the same O2-O3 mixture (10 ml), steroid (1 ml), and local anesthetic (1 ml). Clinical outcomes were evaluated, based on the Oswestry Disability Index (ODI) and pain intensity (0–5) scale results, obtained initially and at 2- and 6-month controls. Our results were analyzed by ANOVA and chi-squared (χ 2) tests. Results Our initial results obtained at 2-month control were promising, indicating a significant decrease in pain disability and intensity in 74% (37) and 76% (38) of the patients respectively, and minimally increased to 76% (38) and 78% (39) at 6-month control (P < 0.001 and CI 99.9%). The mean preprocedure ODI and pain intensity scores were 35 ± 14.36 and 2.38 ± 0.90, respectively, which were reduced to 19.36 ± 13.12 and 1.04 ± 0.92 at 6-month control. Our failure had been mostly related to long symptoms duration of more than 1 year. No complications were recorded. Conclusion Ozone nucleolysis is a safe cost-effective minimally invasive technique for treatment of contained and uncontained lumbar disc herniations.

scholarly journals Bowel Injury following Lumbar Discectomy using Minimally Invasive Retractors

2007 ◽  
Vol 34 (4) ◽  
pp. 485-487 ◽  
Author(s):  
Aleksa Cenic ◽  
Niv Sne ◽  
Michael Lisi ◽  
Allan Okrainac ◽  
Kesava Reddy
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Lumbar Disc ◽  
Intraoperative Complications ◽  
Adult Population ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Invasive Procedure ◽  
Invasive Technique ◽  
Tubular Retractor

Prevalence of symptomatic lumbar disc herniation is 1-3% in the adult population. When conservative therapy (e.g., physiotherapy, anti-inflammatories, epidural injections, etc.) fails, open microsurgical discectomy is regarded as the treatment of choice.With this procedure, the incidence of injury to visceral bowel is reported to be 3.8 per 10,000 cases. With the recent advent of tubular retractor systems, an increasing number of surgeons are using this minimally invasive procedure to replace traditional open microsurgical discectomy. The advantages include a smaller skin incision and a muscle splitting rather than muscle incising technique. As a result post-operative pain, blood loss and length of hospital stay may decrease significantly. Multiple studies have compared the two surgical techniques with regards to their clinical outcomes. The results of these studies reveal equal if not superior clinical outcomes with the minimally invasive technique. Despite the success of the minimally invasive microdiscectomy, none of the studies reported any intraoperative complications using this novel technique.

MINIMALLY INVASIVE POSTEROLATERAL THORACIC CORPECTOMY

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. 746-753 ◽  
Author(s):  
Dae-Hyun Kim ◽  
John E. O'Toole ◽  
Alfred T. Ogden ◽  
Kurt M. Eichholz ◽  
John Song ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cancer Metastasis ◽  
Burst Fracture ◽  
Invasive Technique ◽  
Complication Rates ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Vertebral Bodies ◽  
Clinical Cases

Abstract OBJECTIVE To demonstrate the feasibility of and initial clinical experience with a novel minimally invasive posterolateral thoracic corpectomy technique. METHODS Seven procedures were performed on 6 cadavers to determine the feasibility of thoracic corpectomy using a minimally invasive approach. The posterolateral thoracic corpectomies were performed with expandable 22 mm diameter tubular retractor paramedian incisions. The posterolateral aspects of the vertebral bodies were accessed extrapleurally, and complete corpectomies were performed. Intraprocedural fluoroscopy and postoperative computed tomography were used to assess the degree of decompression. In addition, 2 clinical cases of T6 burst fracture, 1 T4–T5 plasmacytoma, and 1 T12 colon cancer metastasis were treated using this minimally invasive approach. RESULTS In the cadaveric study, an average of 93% of the ventral canal and 80% of the corresponding vertebral body were removed. The pleura and intrathoracic contents were not violated. Adequate exposure was obtained to allow interbody grafting between the adjacent vertebral bodies. The procedures were successfully performed in the 4 clinical cases using a minimally invasive technique, and the patients demonstrated good outcomes. CONCLUSION Based on this study, minimally invasive posterolateral thoracic corpectomy safely and successfully allows complete spinal canal decompression without the tissue disruption associated with open thoracotomy. This approach may improve the complication rates that accompany open or even thoracoscopic approaches for thoracic corpectomy and may even allow surgical intervention in patients with significant comorbidities.

Initial Experience Using a High-Definition 3-Dimensional Exoscope System for Microneurosurgery

2017 ◽  
Vol 14 (4) ◽  
pp. 395-401 ◽  
Author(s):  
Jayson Sack ◽  
Jeffrey A Steinberg ◽  
Robert C Rennert ◽  
Dustin Hatefi ◽  
Jeffrey S Pannell ◽  
...  
Keyword(s):  
Neutral Position ◽  
The Novel ◽  
Operating Microscope ◽  
High Definition ◽  
Team Members ◽  
3 Dimensional ◽  
Primary Operator ◽  
Low Profile ◽  
Standard Operating ◽  
Operative Microscope

Abstract BACKGROUND The operative microscope and endoscope have significantly advanced modern neurosurgery. These devices are nonetheless limited by high costs and suboptimal optics, ergonomics, and maneuverability. A recently developed extracorporeal telescope (“exoscope”) operative system combines characteristics from both the operative microscope and endoscope and provides an affordable, portable, high-definition operative experience. Widespread use of exoscopes in neurosurgery has previously been limited by a lack of stereopsis with 2-dimensional(2-D) monitors. OBJECTIVE To assess the surgical potential of a novel, 3-D, high-definition (4K-HD) exoscope system. METHODS Assess dissection time and visualization of critical structures in a series of human cadaveric cranial neurosurgical approaches with the 3-D 4K-HD exoscope as compared to a standard operating microscope. RESULTS Dissection times and visualization of critical structures was comparable with the 3-D 4K-HD exoscope and a standard operating microscope. The low-profile exoscope nonetheless allowed for larger operative corridors, enhanced instrument maneuverability, and less obstruction in passing instrumentation. The large monitor also resulted in an immersive surgical experience, and gave multiple team members the same high-quality view as the primary operator. Finally, the exoscope possessed a more ergonomically favorable setup as compared to the traditional microscope, allowing the surgeon to be in a neutral position despite the operative angle. CONCLUSION The novel 3-D 4K-HD exoscope system possesses favorable optics, ergonomics, and maneuverability as compared to the traditional operating microscope, with the exoscope's shared surgical view possessing obvious educational and workflow advantages. Further clinical trials are justified to validate this initial cadaveric experience.

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