scholarly journals Minimally Invasive versus Open Hallux Valgus Surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005
Author(s):  
Arno Frigg ◽  
Alex Pellegrino ◽  
Gerardo Maquieira
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Open Surgery ◽  
Removal Rate ◽  
Soft Tissue Injury ◽  
Surgical Techniques ◽  
Scientific Data ◽  
Independent Study ◽  
Similar Amount ◽  
Flexion Extension

Category: Bunion Introduction/Purpose: About 20% of patients suffer from stiffness (arthrofibrosis) after hallux valgus surgery. Minimally Invasive Surgery (MIS) has been invented to reduce the rate of unfavorable result, MIS enjoys increasing popularity with both surgeons and patients and is applied in a growing number of cases. It is being advertised as delivering better results due to reduced soft tissue injury and quicker recovery while effecting a similar amount of deformity correction. However, to date there are no scientific data to support this claim. The aim of the current project is to fill this lacuna by comparing the outcomes of MIS and open hallux valgus surgeries prospectively at our institution. Methods: From 01/2014 to 12/2015, 123 patients were operated: 75 open (average age 51 years, 91% female) and 48 MIS (age 47 years, 88% female). Inclusion criteria were either open Chevron/Scarf or MIS-Chevron at our Foot and Ankle Center with 5 different hospitals and three surgeons. Exclusion criteria were radiological signs of osteoarthritis, extension of less than 30°, pain on motion or during the night, and all other hallux valgus surgeries (lapidus, open wedge, Akin and buniektomy only). Radiographs were taken of all patients 6 weeks and 1 year postop. All patient charts were screened by an independent research assistant for complications and reoperations. All radiographs were measured by two independent observers. All patients were examined in a blinded control by an independent study nurse at 24±6 months after surgery for the clinical results (for parameters please see Tab. 1). Results: All clinical and radiographic results, as well as all additional surgeries, reoperations and complications are shown in Tab.1. The results show that open and MIS surgery achieved a similar gain in AOFAS-score, flexion, extension, VAS and subjective foot value. The scar was significantly smaller in MIS than open, but the satisfaction with the scar was similar. The radiographic correction was equal. Open surgery was combined with more additional procedures than MIS, especially Weil osteotomies and plantar plate repairs. The rate of CRPS, prolonged pain, and stiffness was equal. The reoperation rate was significantly higher for MIS due to a screw removal rate of 34%. Conclusion: MIS is an interesting concept, but it enjoys no advantages over open surgery, at least when carried out with current methods. Calls for open-trained surgeons to switch to MIS are therefore premature. Both surgical techniques have similar clinical and radiological outcomes, while MIS had a higher screw removal rate. Furthermore, complex cases have to be operated with open surgery.

Retrieval of retained Jamshidi needle fragments during minimally invasive surgery

2011 ◽  
Vol 14 (5) ◽  
pp. 681-684 ◽  
Author(s):  
Michael Y. Wang ◽  
Spencer Block
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Invasive Surgery ◽  
Open Surgery ◽  
Intraoperative Complications ◽  
Surgical Techniques ◽  
Spinal Fixation ◽  
Anatomical Structures ◽  
Surrounding Bone

As surgical techniques evolve, new intraoperative complications are prone to occur. With percutaneous spinal fixation, the control of implants and instruments can be a challenge when compared with open surgery, particularly if unintended instruments are retained or difficult to retrieve. In this report, the authors describe a case in which Jamshidi needle fragments broke within the vertebral body. Extraction of the fragments was accomplished using a small pedicle screw tap to first engage the retained metal and then to loosen the surrounding bone to allow retrieval and preservation of the anatomical structures needed to complete the intended operation. This technique may prove useful for the retrieval of deformable, cannulated metal pieces in minimally invasive surgery.

scholarly journals Percutaneous, MIS and open hallux valgus surgery

2021 ◽  
Vol 6 (6) ◽  
pp. 432-438
Author(s):  
Hans-Jörg Trnka
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
First Generation ◽  
Second Generation ◽  
Surgical Techniques ◽  
Metatarsal Head ◽  
Medullary Canal ◽  
Third Generation ◽  
First Metatarsal ◽  
Minimal Incision

There is some confusion in the terminology used when referring to MIS (Minimal invasive surgery) or percutaneous surgery. The correct term to describe these procedures should be percutaneous (made through the skin) and MIS should be reserved for procedures whose extent is between percutaneous and open surgery (e.g. osteosynthesis). Minimal incision surgery may be distinguished in first, second and third generation minimal incision surgery techniques. First generation MIS hallux valgus surgery is mainly connected with the Isham procedure; an intraarticular oblique and incomplete osteotomy of the head of the first metatarsal without fixation. The Bösch osteotomy and the SERI are classified as second generation MIS hallux surgery. They are both transverse subcapital osteotomies fixed with a percutaneous medial K-wire inserted into the medullary canal. For all these procedures, intraoperative fluoroscopic control is necessary. Open hallux valgus surgery can be divided into proximal, diaphyseal and distal osteotomies of the first metatarsal. Reviewing the available literature suggests minimally invasive and percutaneous hallux valgus correction leads to similar clinical and radiological results to those for open chevron or SCARF osteotomies. First generation minimally invasive techniques are primarily recommended for minor deformities. In second generation minimally invasive hallux valgus surgery, up to 61% malunion of the metatarsal head is reported. Once surgeons are past the learning curve, third generation minimally invasive chevron osteotomies can present similar clinical and radiological outcomes to open surgeries. Specific cadaveric training is mandatory for any surgeon considering performing minimally invasive surgical techniques. Cite this article: EFORT Open Rev 2021;6:432-438. DOI: 10.1302/2058-5241.6.210029

Minimally Invasive Surgical Techniques in Hallux Valgus Correction

2015 ◽  
pp. 30-30
Author(s):  
Lyndon Mason ◽  
Kartik Hariharan ◽  
Andy Molloy ◽  
David Redfern ◽  
Anthony Perera
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Surgical Techniques ◽  
Minimally Invasive Surgical

scholarly journals Comparison of radiographic results after minimally invasive, hybrid, and open surgery for adult spinal deformity: a multicenter study of 184 patients

2014 ◽  
Vol 36 (5) ◽  
pp. E13 ◽  
Author(s):  
Raqeeb M. Haque ◽  
Gregory M. Mundis ◽  
Yousef Ahmed ◽  
Tarek Y. El Ahmadieh ◽  
Michael Y. Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Deformity ◽  
Open Surgery ◽  
Adult Spinal Deformity ◽  
Surgical Techniques ◽  
Vertical Axis ◽  
Open Group ◽  
Hybrid Surgery ◽  
Sagittal Vertical Axis ◽  
Hybrid Group

Object Various surgical approaches, including open, minimally invasive, and hybrid techniques, have gained momentum in the management of adult spinal deformity. However, few data exist on the radiographic outcomes of different surgical techniques. The objective of this study was to compare the radiographic and clinical outcomes of the surgical techniques used in the treatment of adult spinal deformity. Methods The authors conducted a retrospective review of two adult spinal deformity patient databases, a prospective open surgery database and a retrospective minimally invasive surgery (MIS) and hybrid surgery database. The time frame of enrollment in this study was from 2007 to 2012. Spinal deformity patients were stratified into 3 surgery groups: MIS, hybrid surgery, and open surgery. The following pre- and postoperative radiographic parameters were assessed: lumbar major Cobb angle, lumbar lordosis, pelvic incidence minus lumbar lordosis (PI−LL), sagittal vertical axis, and pelvic tilt. Scores on the Oswestry Disability Index (ODI) and a visual analog scale (VAS) for both back and leg pain were also obtained from each patient. Results Of the 234 patients with adult spinal deformity, 184 patients had pre- and postoperative radiographs and were thus included in the study (MIS, n = 42; hybrid, n = 33; open, n = 109). Patients were a mean of 61.7 years old and had a mean body mass index of 26.9 kg/m2. Regarding radiographic outcomes, the MIS group maintained a significantly smaller mean lumbar Cobb angle (13.1°) after surgery compared with the open group (20.4°, p = 0.002), while the hybrid group had a significantly larger lumbar curve correction (26.6°) compared with the MIS group (18.8°, p = 0.045). The mean change in the PI−LL was larger for the hybrid group (20.6°) compared with the open (10.2°, p = 0.023) and MIS groups (5.5°, p = 0.003). The mean sagittal vertical axis correction was greater for the open group (25 mm) compared with the MIS group (≤ 1 mm, p = 0.008). Patients in the open group had a significantly larger postoperative thoracic kyphosis (41.45°) compared with the MIS patients (33.5°, p = 0.005). There were no significant differences between groups in terms of pre- and postoperative mean ODI and VAS scores at the 1-year follow-up. However, patients in the MIS group had much lower estimated blood loss and transfusion rates compared with patients in the hybrid or open groups (p < 0.001). Operating room time was significantly longer with the hybrid group compared with the MIS and open groups (p < 0.001). Major complications occurred in 14% of patients in the MIS group, 14% in the hybrid group, and 45% in the open group (p = 0.032). Conclusions This study provides valuable baseline characteristics of radiographic parameters among 3 different surgical techniques used in the treatment of adult spinal deformity. Each technique has advantages, but much like any surgical technique, the positive and negative elements must be considered when tailoring a treatment to a patient. Minimally invasive surgical techniques can result in clinical outcomes at 1 year comparable to those obtained from hybrid and open surgical techniques.

scholarly journals Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

2014 ◽  
Vol 36 (5) ◽  
pp. E15 ◽  
Author(s):  
Juan S. Uribe ◽  
Armen R. Deukmedjian ◽  
Praveen V. Mummaneni ◽  
Kai-Ming G. Fu ◽  
Gregory M. Mundis ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Deformity ◽  
Open Surgery ◽  
Adult Spinal Deformity ◽  
Intraoperative Complications ◽  
Surgical Techniques ◽  
Open Group ◽  
Inclusion Criteria ◽  
Significant Difference

Object It is hypothesized that minimally invasive surgical techniques lead to fewer complications than open surgery for adult spinal deformity (ASD). The goal of this study was to analyze matched patient cohorts in an attempt to isolate the impact of approach on adverse events. Methods Two multicenter databases queried for patients with ASD treated via surgery and at least 1 year of follow-up revealed 280 patients who had undergone minimally invasive surgery (MIS) or a hybrid procedure (HYB; n = 85) or open surgery (OPEN; n = 195). These patients were divided into 3 separate groups based on the approach performed and were propensity matched for age, preoperative sagittal vertebral axis (SVA), number of levels fused posteriorly, and lumbar coronal Cobb angle (CCA) in an attempt to neutralize these patient variables and to make conclusions based on approach only. Inclusion criteria for both databases were similar, and inclusion criteria specific to this study consisted of an age > 45 years, CCA > 20°, 3 or more levels of fusion, and minimum of 1 year of follow-up. Patients in the OPEN group with a thoracic CCA > 75° were excluded to further ensure a more homogeneous patient population. Results In all, 60 matched patients were available for analysis (MIS = 20, HYB = 20, OPEN = 20). Blood loss was less in the MIS group than in the HYB and OPEN groups, but a significant difference was only found between the MIS and the OPEN group (669 vs 2322 ml, p = 0.001). The MIS and HYB groups had more fused interbody levels (4.5 and 4.1, respectively) than the OPEN group (1.6, p < 0.001). The OPEN group had less operative time than either the MIS or HYB group, but it was only statistically different from the HYB group (367 vs 665 minutes, p < 0.001). There was no significant difference in the duration of hospital stay among the groups. In patients with complete data, the overall complication rate was 45.5% (25 of 55). There was no significant difference in the total complication rate among the MIS, HYB, and OPEN groups (30%, 47%, and 63%, respectively; p = 0.147). No intraoperative complications were reported for the MIS group, 5.3% for the HYB group, and 25% for the OPEN group (p < 0.03). At least one postoperative complication occurred in 30%, 47%, and 50% (p = 0.40) of the MIS, HYB, and OPEN groups, respectively. One major complication occurred in 30%, 47%, and 63% (p = 0.147) of the MIS, HYB, and OPEN groups, respectively. All patients had significant improvement in both the Oswestry Disability Index (ODI) and visual analog scale scores after surgery (p < 0.001), although the MIS group did not have significant improvement in leg pain. The occurrence of complications had no impact on the ODI. Conclusions Results in this study suggest that the surgical approach may impact complications. The MIS group had significantly fewer intraoperative complications than did either the HYB or OPEN groups. If the goals of ASD surgery can be achieved, consideration should be given to less invasive techniques.

Minimally invasive surgery for hallux valgus: a systematic review of current surgical techniques.

2018 ◽  
Vol 43 (3) ◽  
pp. 625-637 ◽  
Author(s):  
Francesc Malagelada ◽  
Cyrus Sahirad ◽  
Miki Dalmau-Pastor ◽  
Jordi Vega ◽  
Rej Bhumbra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Hallux Valgus ◽  
Invasive Surgery ◽  
Surgical Techniques

Minimally Invasive Hallux Valgus Surgery. A Systematic Review

2018 ◽  
Vol 2 (2) ◽  
pp. 91-98
Author(s):  
Edvin Selmani ◽  
Fatmir Brahimi ◽  
Leard Duraj ◽  
Valbona Selmani ◽  
Gjergji Syko ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Hallux Valgus

Use of endoscopic transorbital and endonasal approaches for 360° circumferential access to orbital tumors

2020 ◽  
pp. 1-10
Author(s):  
Chiman Jeon ◽  
Sang Duk Hong ◽  
Kyung In Woo ◽  
Ho Jun Seol ◽  
Do-Hyun Nam ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Minimally Invasive ◽  
Surgical Techniques ◽  
Cystic Teratoma ◽  
Subtotal Resection ◽  
Zone Model ◽  
Team Approach ◽  
Orbital Tumors ◽  
Total Resection ◽  
Endoscopic Transorbital

OBJECTIVEOrbital tumors are often surgically challenging because they require an extensive fronto-temporo-orbital zygomatic approach (FTOZ) and a multidisciplinary team approach to provide the best outcomes. Recently, minimally invasive endoscopic techniques via a transorbital superior eyelid approach (ETOA) or endoscopic endonasal approach (EEA) have been proposed as viable alternatives to transcranial approaches for orbital tumors. In this study, the authors investigated the feasibility of 360° circumferential access to orbital tumors via both ETOA and EEA.METHODSBetween April 2014 and June 2019, 16 patients with orbital tumors underwent either ETOA or EEA at the authors’ institution. Based on the neuro-topographic “four-zone model” of the orbit with its tumor epicenter around the optic nerve in the coronal plane, ETOA (n = 10, 62.5%) was performed for tumors located predominantly superolateral to the nerve and EEA (n = 6, 37.5%) for those located predominantly inferomedial to the nerve. Eight patients (50%) presented with intraconal tumors and 8 (50%) with extraconal ones. The orbital tumors included orbital schwannoma (n = 6), cavernous hemangioma (n = 2), olfactory groove meningioma (n = 1), sphenoorbital meningioma (n = 1), chondrosarcoma (n = 1), trigeminal schwannoma (n = 1), metastatic osteosarcoma (n = 1), mature cystic teratoma (n = 1), sebaceous carcinoma (n = 1), and ethmoid sinus osteoma (n = 1). The clinical outcomes and details of surgical techniques were reviewed.RESULTSGross-total resection was achieved in 12 patients (75%), near-total resection in 3 (18.8%), and subtotal resection in 1 (6.2%). Eight (88.9%) of the 9 patients with preoperative proptosis showed improvement after surgery, and 4 (66.7%) of the 6 patients with visual symptoms demonstrated improvement. Four (40%) of the 10 patients treated with ETOA experienced partial third nerve palsy immediately after surgery (3 transient and 1 persistent). There have been no postoperative CSF leaks or infections in this series.CONCLUSIONSWithout transcranial approaches requiring temporalis muscle dissection and orbitozygomatic osteotomy, the selection of ETOA or EEA based on a concept of a four-zone model with its epicenter around the optic nerve successfully provides a minimally invasive 360° circumferential access to the entire orbit with acceptable morbidity.

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