scholarly journals Ten-Step Minimally Invasive Spine Lumbar Decompression and Dural Repair Through Tubular Retractors

2017 ◽  
Vol 13 (2) ◽  
pp. 232-245 ◽  
Author(s):  
Mohamed Abdelatif Boukebir ◽  
Connor David Berlin ◽  
Rodrigo Navarro-Ramirez ◽  
Tim Heiland ◽  
Karsten Schöller ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc ◽  
Surgical Techniques ◽  
Synovial Cyst ◽  
Clinical Results ◽  
Complication Management ◽  
Lumbar Degenerative Disease ◽  
Dural Repair ◽  
Microsurgical Techniques ◽  
Minimally Invasive Spine

Abstract BACKGROUND: Minimally invasive spine (MIS) surgery utilizing tubular retractors has become an increasingly popular approach for decompression in the lumbar spine. However, a better understanding of appropriate indications, efficacious surgical techniques, limitations, and complication management is required to effectively teach the procedure and to facilitate the learning curve. OBJECTIVE: To describe our experience and recommendations regarding tubular surgery for lumbar disc herniations, foraminal compression with unilateral radiculopathy, lumbar spinal stenosis, synovial cysts, and dural repair. METHODS: We reviewed our experience between 2008 and 2014 to develop a step-by-step description of the surgical techniques and complication management, including dural repair through tubes, for the 4 lumbar pathologies of highest frequency. We provide additional supplementary videos for dural tear repair, laminotomy for bilateral decompression, and synovial cyst resection. RESULTS: Our overview and complementary materials document the key technical details to maximize the success of the 4 MIS surgical techniques. The review of our experience in 331 patients reveals technical feasibility as well as satisfying clinical results, with no postoperative complications associated with cerebrospinal fluid leaks, 1 infection, and 17 instances (5.1%) of delayed fusion. CONCLUSION: MIS surgery through tubular retractors is a safe and effective alternative to traditional open or microsurgical techniques for the treatment of lumbar degenerative disease. Adherence to strict microsurgical techniques will allow the surgeon to effectively address bilateral pathology while preserving stability and minimizing complications.

Minimally Invasive Surgical Treatment of Lumbar Synovial Cysts

Neurosurgery ◽  
2004 ◽  
Vol 54 (1) ◽  
pp. 107-112 ◽  
Author(s):  
Faheem A. Sandhu ◽  
Paul Santiago ◽  
Richard G. Fessler ◽  
Sylvain Palmer
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Surgical Techniques ◽  
Synovial Cyst ◽  
Complete Excision ◽  
Tubular Retractor ◽  
Minimally Invasive Surgical ◽  
Average Patient ◽  
Synovial Cysts

Abstract OBJECTIVE Synovial cysts are a rare cause of lumbar radiculopathy and back pain. Surgical treatment is directed at complete excision of the cyst. We used minimally invasive surgical techniques for a series of patients, to assess the effectiveness of this approach for resection of synovial cysts. METHODS Seventeen patients (10 female and 7 male patients) with presumed synovial cysts, as indicated on magnetic resonance imaging scans, underwent surgical resection with the 18-mm METRx tubular retractor system (Medtronic Sofamor Danek, Memphis, TN). A unilateral approach was used, with either an operating microscope (13 cases) or a magnifying endoscope (4 cases), depending on the preference of the surgeon. Outcomes were reported by using modified MacNab criteria. RESULTS The average patient age was 64 years (range, 46–82 yr). The L4–L5 level was most commonly affected (82% of cases). Grade 1 spondylolisthesis at the level harboring the synovial cyst was observed for 47% of the patients; all cases of spondylolisthesis involved the L4–L5 level. The mean operative time was 97 minutes, and the average blood loss was 35 ml. Excellent or good results were achieved for 94% of the patients. A dural tear that did not violate the arachnoid membrane occurred during surgery for one patient but did not require further treatment. CONCLUSION Synovial cysts can be effectively treated with a tubular retractor system in conjunction with an endoscope or microscope. Use of the tubular retractor minimizes soft-tissue trauma, incision length, blood loss, and disruption of ligamentous and bony structures. This may be particularly significant when synovial cysts are associated with spondylolisthesis, minimizing the risk of progressive instability and the need for fusion.

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.

Clinical Results of Minimally Invasive Spine Stabilization for Spinal Metastases

Orthopedics ◽  
2017 ◽  
Vol 40 (4) ◽  
pp. e693-e698 ◽  
Author(s):  
Hiroshi Uei ◽  
Yasuaki Tokuhashi ◽  
Masashi Oshima ◽  
Masafumi Maseda ◽  
Koji Matsumoto ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Metastases ◽  
Clinical Results ◽  
Spine Stabilization ◽  
Minimally Invasive Spine ◽  
Minimally Invasive Spine Stabilization

scholarly journals Introduction: Minimally Invasive Spine Surgery video supplement

2013 ◽  
Vol 35 (v2supplement) ◽  
pp. Intro
Author(s):  
Praveen V. Mummaneni
Keyword(s):  
Minimally Invasive ◽  
Spine Surgery ◽  
Length Of Hospital Stay ◽  
Minimally Invasive Spine Surgery ◽  
Invasive Treatment ◽  
Lumbar Degenerative Disease ◽  
Minimally Invasive Spinal Surgery ◽  
Lower Blood ◽  
Spinal Deformity Surgery ◽  
Minimally Invasive Spine

This video supplement of Neurosurgery Focus is devoted to minimally invasive spine surgery. Minimally invasive spine surgery has gained popularity amongst patients and physicians over the past decade because it has been shown in select instances to lower blood loss and reduce length of hospital stay for appropriately selected candidates.This supplement includes videos from many of the leaders in the field. Pioneers like Frank LaMarca, Paul Park, Cheerag Upadhyaya, Juan Uribe, and Mike Wang have all sent in videos depicting minimally invasive spinal deformity surgery options. The supplement also includes videos from several different countries, demonstrating how widespread and nuanced minimally invasive spinal procedures have become. Drs. Barbagallo, Certo, Sciacca, and Albanese from Italy; Drs. Gragnaniello and Seex from Australia; and Drs. Liao, Wu, Huang, Wang, Chang, Cheng, and Shih from Taiwan have all sent in nuanced surgical videos that will be of interest to many viewers.I personally enjoyed viewing videos on lumbar degenerative disease surgery depicting unique surgical nuances to treat common problems. Dr. Beejal Amin, Dr. Harel Deutsch, Dr. Daniel Lu, and Dr. Adam Kanter have each submitted videos depicting lumbar decompression and/or fusion for lumbar degenerative stenosis and spondylosis.This supplement also included videos depicting the minimally invasive treatment of uncommon spinal pathologies as well. Videos from Dr. Fred Geisler, Dr. John O'Toole, and Dr. Noel Perin covered topics as varied as sacroiliac joint dysfunction, spinal arteriovenous malformations, and sympathetic chain surgery.I hope that you enjoy this issue of Neurosurgical Focus devoted to videos depicting the surgical nuances of minimally invasive spinal surgery. This video supplement has international appeal, and it has been an honor to be a guest editor on this superb supplement.

scholarly journals Computed Tomography- (CT-) Based Virtual Surgery Planning for Spinal Intervertebral Foraminal Assisted Clinical Treatment

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Hao Li ◽  
Song Wang ◽  
Jinlong Tang ◽  
Jibin Wu ◽  
Yong Liu
Keyword(s):  
Minimally Invasive ◽  
Soft Tissues ◽  
Lumbar Disc ◽  
Postoperative Recovery ◽  
Structure Alignment ◽  
Virtual Surgery ◽  
Surgical Trauma ◽  
Coronary Ct ◽  
Paravertebral Muscles ◽  
Minimally Invasive Spine

With the development of minimally invasive spine concepts and the introduction of new minimally invasive instruments, minimally invasive spine technology, represented by foraminoscopy, has flourished, and percutaneous foraminoscopy has become one of the most reliable minimally invasive procedures for the treatment of lumbar disc herniation. Percutaneous foraminoscopy is a safe and effective minimally invasive spinal endoscopic surgical technique. It fully protects the paravertebral muscles and soft tissues as well as the posterior column structure of the spine, provides precise treatment of the target nucleus pulposus tissue, with the advantages of less surgical trauma, fewer postoperative complications, and rapid postoperative recovery, and is widely promoted and used in clinical practice. In this paper, we can view the location, morphology, structure, alignment, and adjacency relationships by performing coronary, CT, and diagonal reconstruction along the attachment of the yellow ligaments and performing 3D reconstruction or processing techniques after performing CT scans. This allows clinicians to observe the laminoplasty and the stenosis of the vertebral canal in a more intuitive and overall manner. It has clinical significance for the display of the sublaminar spine as well as the physician’s judgment of the disease and the choice of surgery.

scholarly journals The Current State of Endoscopic Disc Surgery: Review of Controlled Studies Comparing FullEndoscopic Procedures for Disc Herniations to Standard Procedures

2013 ◽  
Vol 4;16 (4;7) ◽  
pp. 335-344
Author(s):  
Christof Birkenmaier
Keyword(s):  
Neuropathic Pain ◽  
Lumbar Disc ◽  
Standard Procedure ◽  
Clinical Results ◽  
Endoscopic Technique ◽  
Complication Rates ◽  
Disc Surgery ◽  
Standard Procedures ◽  
Disc Herniations ◽  
Microsurgical Techniques

Background: Neuropathic pain originating from spinal disc herniations is a very common problem. The majority of disc surgeries are performed to alleviate this pain once conservative measures and targeted injections have failed. Endoscopic spinal surgery is increasingly popular because it minimizes access trauma and hastens recovery from the intervention. This clinically oriented review evaluates controlled studies that investigate the clinical results and the complications of full-endoscopic lumbar and cervical procedures for symptomatic disc herniations in comparison to a microsurgical standard procedure. This review focuses exclusively on modern, full-endoscopic disc surgery irrespective of the specific access technique (e.g., interlaminar vs. transforaminal) and irrespective of the spinal region. Study Design: Comprehensive review of the literature. Objective: To assess the clinical outcomes and complication rates of full-endoscopic disc surgery compared to the microsurgical standard procedures. Methods: A PubMed and Embase search was performed, considering entries up to January 2013. All 504 results were screened and categorized. Only 4 randomized controlled trials (RCTs) and one controlled studies (CS) could finally be considered for evaluation. All 5 manuscripts were meticulously analyzed with regards to randomization mode, inclusion/exclusion criteria, clinical results, and complication rates. Results: Overall, the endoscopic techniques had shorter operating times, less blood loss, less operative site pain, and faster postoperative rehabilitation/shorter hospital stay/faster return to work than the microsurgical techniques. There were no significant differences in the main clinical outcome criteria between the endoscopic and the microsurgical techniques in any of the trials. All 5 studies had fewer complications with the endoscopic technique and this was statistically significant in 2 of the studies. One study showed a lower rate of revision surgeries requiring arthrodesis with the endoscopic technique. Limitations: All 5 studies that could be considered originate from experienced investigators and all 4 RCTs came from one group. This limits the transferability of their results to surgeons less experienced in endoscopic disc surgery. Conclusions: The studies show that full-endoscopic disc surgery can achieve the same clinical results in symptomatic cervical and lumbar disc herniations as the microsurgical standard techniques. This does not appear to come at the price of higher complication rates. Key words: Neuropathic pain, disc herniation, cervical, lumbar, endoscopic, endoscopy, review

scholarly journals Percutaneous Endoscopic Spine Surgery for Extruded Lumbar Disc Herniation

2018 ◽  
Vol 12 (1) ◽  
pp. 482-495
Author(s):  
Mutombo Menga Arsene ◽  
Xiao-Tao Wu ◽  
Zan- Li Jiang ◽  
Lei Zhu
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Spine Surgery ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Techniques ◽  
Surgical Instruments ◽  
Disc Space ◽  
Advanced Technique ◽  
Endoscopic Spine Surgery

The conventional open discectomy is the gold standard for treating extruded lumbar disc herniation, especially in highly migrated lumbar disc herniation. Endoscopic spine surgery is known to be very challenging and technically demanding, in particular for highly migrated disc herniation. However, several studies have reported numerous effective techniques with results approximatively equal to conventional open surgeries or mini-open surgery. In the last few years, an increased number of endoscopic spine surgical techniques have been proposed in order to overcome various issues encountered in traditional endoscopic spine surgery. Nevertheless, surgical approach selection for treating extruded lumbar disc herniation is based on aspects such as anatomical structures, availability of surgical instruments, surgeon’s experience, and the disc herniation location. Advances in endoscopic visualization and instrumentation, as well as an increased demand for minimally invasive procedures, have led to the popularity of Percutaneous Endoscopic Lumbar Discectomy (PELD). PELD is a recent and advanced technique among other minimally invasive spine surgeries (MIS). It includes various kinds of surgical techniques to treat lumbar disc herniation and aims to offer a safe, less invasive surgical procedure for lumbar disc space decompression and removal of nucleus pulposus.

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