Release of Anterior Longitudinal Ligament in Setting of Unfavorable Vascular Anatomy for Anterior Column Realignment—Technical Note: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E189-E189
Author(s):  
Jakub Godzik ◽  
Corey T Walker ◽  
Alexander C Whiting ◽  
Randall J Hlubek ◽  
Juan S Uribe ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Techniques ◽  
Technical Note ◽  
Anterior Column ◽  
Preoperative Imaging ◽  
Invasive Technique ◽  
Anterior Longitudinal Ligament ◽  
Transpsoas Approach ◽  
Patient Consent ◽  
Flat Back

Abstract Anterior column realignment (ACR) with anterior longitudinal ligament (ALL) release from a lateral transpsoas approach is increasingly being used as a minimally invasive technique to restore lordosis. Safe execution requires a plane between the ALL and the anterior vasculature. An unfavorable plane on preoperative imaging is a contraindication to using the technique. We describe a patient undergoing multistage minimally invasive correction of a flat-back deformity who had an unfavorable plane between the ALL and vasculature at L4-5. Patient consent was provided, and Institutional Review Board approval was not required. To safely complete the ALL release and ACR, we elected to sharply incise the lateral aspect of the ligament at L4-5 with direct control of the vessels during the anterior approach for an L5-S1 anterior lumbar interbody fusion. We then moved to the lateral transpsoas approach and used controlled distraction techniques to complete the ALL release and then to complete the ACR in a standard fashion. We ultimately achieved excellent realignment with correction of the patient's flat-back deformity using minimally invasive surgical techniques while minimizing vascular risk. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Minimally Invasive Echo-Guided Placement Of The Cardiac Tube In A Ventriculoatrial Shunt During Pregnancy: Technical Note

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONSE398-ONSE398
Author(s):  
Licia Di Muro ◽  
Roberto Pallini ◽  
Domenico Pietrini ◽  
Christian Colizzi ◽  
Luca Denaro
Keyword(s):  
Minimally Invasive ◽  
Internal Jugular Vein ◽  
Right Atrium ◽  
Jugular Vein ◽  
Technical Note ◽  
Invasive Technique ◽  
Success Rates ◽  
Ventriculoatrial Shunt ◽  
Simple Method ◽  
Sonographic Guidance

Abstract Objective: We describe a minimally invasive echo-guided placement of the cardiac tube in a ventriculoatrial shunt in a young pregnant woman, in order to avoid any radiological procedure. Methods: We used a central venous catheter placement kit for percutaneous echo-guided right internal jugular vein puncture located by a 7.5 mHz microlinear probe. Through the catheter, the distal portion of the shunt device was positioned into the internal jugular vein to the right atrium using ultrasound control by a 2.5 to 3.5 mHz probe in a four-chamber transthoracic view. Results: Sonographic guidance in percutaneous placement of a vertebral artery shunt is a safe and fast minimally invasive technique that improves success rates and decreases complications such as incidental puncture of the carotid artery and pneumothorax. The use of a two-dimensional echocardiographic apparatus in a four-chamber transthoracic view is an accurate and simple method to verify the position of the distal tip of the shunt in the mid-right atrium with no risks for the patient. Conclusion: The use of these two techniques allows a minimally invasive, safe, accurate, and complete x-ray-free procedure.

scholarly journals Transulcal parafascicular minimally invasive approach to deep and subcortical cavernomas: technical note

2016 ◽  
Vol 125 (6) ◽  
pp. 1360-1366 ◽  
Author(s):  
Robert A. Scranton ◽  
Steve H. Fung ◽  
Gavin W. Britz
Keyword(s):  
White Matter ◽  
Minimally Invasive ◽  
Technical Difficulty ◽  
Subcortical White Matter ◽  
Technical Note ◽  
Vascular Lesions ◽  
Invasive Technique ◽  
Minimally Invasive Approach ◽  
Unique Challenge ◽  
Invasive Approach

Cavernomas comprise 8%–15% of intracranial vascular lesions, usually supratentorial in location and superficial. Cavernomas in the thalamus or subcortical white matter represent a unique challenge for surgeons in trying to identify and then use a safe corridor to access and resect the pathology. Previous authors have described specific open microsurgical corridors based on pathology location, often with technical difficulty and morbidity. This series presents 2 cavernomas that were resected using a minimally invasive approach that is less technically demanding and has a good safety profile. The authors report 2 cases of cavernoma: one in the thalamus and brainstem with multiple hemorrhages and the other in eloquent subcortical white matter. These lesions were resected through a transulcal parafascicular approach with a port-based minimally invasive technique. In this series there was complete resection with no neurological complications. The transulcal parafascicular minimally invasive approach relies on image interpretation and trajectory planning, intraoperative navigation, cortical cannulation and subcortical space access, high-quality optics, and resection as key elements to minimize exposure and retraction and maximize tissue preservation. The authors applied this technique to 2 patients with cavernomas in eloquent locations with excellent outcomes.

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

2016 ◽  
Vol 12 (3) ◽  
pp. 214-221 ◽  
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.

scholarly journals Description of a minimally invasive technique with a modified instrument for the osteosynthesis of proximal femoral fractures using the standard DHS and case series

2020 ◽  
Vol 47 ◽  
Author(s):  
RICARDO RAMON CAMACHO IRIGOYEN ◽  
RAFAEL DE LUCA DE-LUCENA ◽  
JEAN KLAY SANTOS MACHADO ◽  
GABRIEL SEVERO DA-SILVA ◽  
CARLOS ROBERTO SCHWARTSMANN ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Techniques ◽  
Case Series ◽  
Femoral Fractures ◽  
Soft Tissue Injuries ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Trochanteric Fractures ◽  
Clinical Complications ◽  
Minimally Invasive Surgical

ABSTRACT Introduction: the number of hip fractures is estimated to increase from 1.66 million in 1990 to 6.26 million by 2050. Internal fixation is the most common surgical treatment for intertrochanteric fractures. Objectives: the objective of the present research is to describe a minimally invasive technique with a modified instrument for the treatment of stable proximal femoral trochanteric fractures using the standard DHS, classified as Tronzo types 1 and 2 (AO 31A1.2), and presenting a case series. Methods: a case was selected to present the technique. Patients operated by this technique undergo a clinical evaluation and preoperative preparation as routine. The criteria for inclusion in the study were the presence of stable fracture of the proximal femur verified by two hip specialist orthopedists, and operated by the minimally invasive technique with a modified instrument using a standard DHS. Exclusion criteria were cases of patients operated for unstable fractures, and the use of other surgical techniques. A case series of 98 patients was performed and discussed. Results: minimally invasive technique with a modified instrument using the standard DHS device can reduce bleeding, it decreases soft tissue injuries, surgical time, and hospital stay, as any other MIPO procedures. Ninety-eight patients underwent the operation (Tronzo types I and II), 59 female and 39 male, ages from 50 to 85 years old. Immediate post-operative complications were shortening of the lower limb, loss of fracture reduction, and death by clinical complications. Conclusion: the present study describes a minimally invasive surgical technique using a modified instrument to perform proximal femoral osteosynthesis for stable trochanteric fractures, using the standard DHS.

Endoszkópos arytaenoid abdukciós lateropexia foniátriai eredményei átmeneti kétoldali gégebénulás esetén

2018 ◽  
Vol 159 (29) ◽  
pp. 1188-1192 ◽  
Author(s):  
Vera Matievics ◽  
Balázs Sztanó ◽  
Ádám Bach ◽  
László Rovó
Keyword(s):  
Minimally Invasive ◽  
Vocal Cord ◽  
Voice Quality ◽  
Surgical Techniques ◽  
Vocal Cord Palsy ◽  
Invasive Technique ◽  
Normal Voice ◽  
Respiratory Outcomes ◽  
The Voice

Abstract: Introduction: Dyspnea caused by bilateral vocal cord paralysis often requires surgical intervention to prevent acute asphyxiation. The regeneration of the laryngeal nerves may last weeks or months and it is difficult to predict the outcome. In the past decades, several open and endoscopic surgical techniques have been introduced for treatment to avoid tracheostomy, however, these procedures with resection of the glottis resulted in irreversible changes in the laryngeal structure, thus the voice quality decreased over a long-term period. Aim: Endoscopic arytenoid abduction lateropexy is an accepted reversible, minimally invasive technique that provides an immediate patent airway by the lateralisation of the arytenoid cartilage with a suture. The aim of our study was to analyze the phonatory and respiratory outcomes of this treatment concept. Method: Two patients suffering from bilateral vocal cord palsy were treated with endoscopic arytenoid abduction lateropexy. After recovery of the vocal cord movements, the sutures were removed. Spirometric and phoniatric results of the two patients were analysed after suture removal. Results: Good spirometric parameters and normal voice quality were detected in both cases. Conclusions: These results prove the high reversibility of the minimally invasive endoscopic arytenoid abduction lateropexy. Lateralization suture can be removed in the case of vocal cord movement recovery, and phonation may be physiological. Orv Hetil. 2018; 159(29): 1188–1192.

Anterior longitudinal ligament release using the minimally invasive lateral retroperitoneal transpsoas approach: a cadaveric feasibility study and report of 4 clinical cases

2012 ◽  
Vol 17 (6) ◽  
pp. 530-539 ◽  
Author(s):  
Armen R. Deukmedjian ◽  
Tien V. Le ◽  
Ali A. Baaj ◽  
Elias Dakwar ◽  
Donald A. Smith ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lumbar Lordosis ◽  
Lumbar Disc ◽  
Vena Cava ◽  
Surgical Anatomy ◽  
Sagittal Imbalance ◽  
Anterior Longitudinal Ligament ◽  
Vertebral Column Resection ◽  
Transpsoas Approach ◽  
Clinical Cases

Object Traditional procedures for correction of sagittal imbalance via shortening of the posterior column include the Smith-Petersen osteotomy, pedicle subtraction osteotomy, and vertebral column resection. These procedures require wide exposure of the spinal column posteriorly, and may be associated with significant morbidity. Anterior longitudinal ligament (ALL) release using the minimally invasive lateral retroperitoneal approach with a resultant net lengthening of the anterior column has been performed as an alternative to increase lordosis. The objective of this study was to demonstrate the feasibility and early clinical experience of ALL release through a minimally invasive lateral retroperitoneal transpsoas approach, as well as to describe its surgical anatomy in the lumbar spine. Methods Forty-eight lumbar levels were dissected in 12 fresh-frozen cadaveric specimens to study the anatomy of the ALL as well as its surrounding structures, and to determine the feasibility of the technique. The lumbar disc spaces and ALL were accessed via the lateral transpsoas approach and confirmed with fluoroscopy in each specimen. As an adjunct, 4 clinical cases of ALL release through the minimally invasive lateral retroperitoneal transpsoas approach were reviewed. Operative technique, results, complications, and early outcomes were assessed. Results In the cadaveric study, sectioning of the ALL proved to be feasible from the minimally invasive lateral retroperitoneal transpsoas approach. The structures at most immediate risk during this procedure were the aorta, inferior vena cava, iliac vessels, and sympathetic plexus. The mean increase in segmental lumbar lordosis per level of ALL release was 10.2°, while global lumbar lordosis improved by 25°. Each level of ALL release took 56 minutes and produced 40 ml of blood loss on average. Visual analog scale and Oswestry Disability Index scores improved by 9 and 35 points, respectively. There were no cases of hardware failure, and as of yet no complications to report. Conclusions This initial experience suggests that ALL release through the minimally invasive lateral retroperitoneal transpsoas approach may be feasible, allows for improvement of lumbar lordosis without the need of an open laparotomy/thoracotomy, and minimizes the tissue disruption and morbidity associated with posterior osteotomies.

scholarly journals Contralateral psoas hematoma after minimally invasive, lateral retroperitoneal transpsoas lumbar interbody fusion: a multicenter review of 3950 lumbar levels

2017 ◽  
Vol 26 (1) ◽  
pp. 50-54 ◽  
Author(s):  
Joshua M. Beckman ◽  
Berney Vincent ◽  
Michael S. Park ◽  
James B. Billys ◽  
Robert E. Isaacs ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Rare Complication ◽  
Neurological Deficits ◽  
Preoperative Imaging ◽  
Lumbar Interbody Fusion ◽  
Segmental Artery ◽  
Delay In Diagnosis ◽  
Transpsoas Approach ◽  
Vessel Injury

OBJECTIVE Minimally invasive lateral lumbar interbody fusion (LLIF) via the retroperitoneal transpsoas approach is a technically demanding procedure with a multitude of potential complications. A relatively unknown complication is the contralateral psoas hematoma. The authors speculate that injury occurs from segmental vessel injury at the time of contralateral annulus release; however, this is not fully understood. In this multicenter retrospective review, the authors report the incidence of this contralateral complication and its neurological sequelae. METHODS This study was a retrospective chart review of all minimally invasive LLIF performed at participating institutions from 2008 to 2014. Exclusion criteria included an underlying diagnosis of trauma or neoplasia as well as lateral corpectomies or anterior column releases. Single-level, multilevel, and stand-alone constructs were included. All patients underwent preoperative MRI. Follow-up was at least 12 months. All complications and clinical outcomes were self-reported by each surgeon. RESULTS There were 3950 lumbar interbody cages placed via the retroperitoneal transpsoas approach, with 7 cases (0.18% incidence) of symptomatic contralateral psoas hematoma, 3 of which required reoperation for hematoma evacuation. Neurological outcome did not improve after reoperation. Reoperation occurred an average of 1 month after the initial operation due to a delay in diagnosis. In 1 case, segmental artery injury was confirmed at the time of surgery; in the others, segmental vessel injury was suspected, although it could not be confirmed. Neurological deficits persisted in 3 patients while the others remained neurologically intact. Two patients were receiving antiplatelet therapy prior to the procedure. CONCLUSIONS The contralateral psoas hematoma is a rare complication suspected to occur from segmental vessel injury during contralateral annulus release. Detailed review of preoperative imaging for aberrant vessel anatomy may prevent injury and subsequent neurological deficit.

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.

scholarly journals Stereotactic navigation for the prepsoas oblique lateral lumbar interbody fusion: technical note and case series

2017 ◽  
Vol 43 (2) ◽  
pp. E14 ◽  
Author(s):  
Anthony M. DiGiorgio ◽  
Caleb S. Edwards ◽  
Michael S. Virk ◽  
Praveen V. Mummaneni ◽  
Dean Chou
Keyword(s):  
Interbody Fusion ◽  
Case Series ◽  
Psoas Muscle ◽  
Technical Note ◽  
Invasive Technique ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion ◽  
Transpsoas Approach ◽  
Technical Report ◽  
Stereotactic Navigation

The prepsoas retroperitoneal approach is a minimally invasive technique used for anterior lumbar interbody fusion. The approach may have a more favorable risk profile than the transpsoas approach, decreasing the risks that come with dissecting through the psoas muscle. However, the oblique angle of the spine in the prepsoas approach can be disorienting and challenging. This technical report provides an overview of the use of navigation in prepsoas oblique lateral lumbar interbody fusion in a series of 49 patients.

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