Is Vertebral Body Tethering Truly Minimally Invasive? A Comparison of Early Post-Operative Outcomes to Posterior Spinal Instrumentation and Fusion

Abstract INTRODUCTION Posterior spinal instrumentation for fusion using intraoperative computed tomography (CT) navigation is gaining traction as an alternative to the conventional two-dimensional fluoroscopic-guided approach to percutaneous pedicle screw placement. However, few studies to date have directly compared outcomes of these 2 minimally invasive instrumentation methods. METHODS A consecutive cohort of patients undergoing primary percutaneous posterior lumbar spine instrumentation for spine fusion was retrospectively reviewed. Revision surgeries or cases converted to open were excluded. Accuracy of screw placement was assessed using a postoperative CT scan with blinding to the surgical methods used. The Gertzbein-Robbins classification was used to grade cortical breach: Grade 0 (<0 mm cortical breach), Grade I (<2 mm), Grade II (2-4 mm), Grade III (4-6 mm), and Grade IV (>6 mm). RESULTS CT navigation was found to significantly improve accuracy of screw placement (P < .022). There was significantly more facet violation of the unfused level in the fluoroscopy group vs the CT group (9% vs 0.5%; P < .0001). There was also a higher proportion of poor screw placement in the fluoroscopy group (10.1% vs 3.6%). No statistical difference was found in the rate of tip breach, inferomedial breach, or lateral breach. Regression analysis showed that fluoroscopy had twice the odds of incurring poor screw placement as compared to CT navigation. CONCLUSION This radiographic study comparing screw placement in minimally invasive fluoroscopy- vs CT navigation-guided lumbar spine instrumentation provides evidence that CT navigation significantly improves accuracy of screw placement, especially in optimizing the screw trajectory so as to avoid facet violation. Long-term follow-up studies should be performed to ascertain whether this difference can contribute to an improvement in clinical outcomes.

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Minimally Invasive Reconstruction of Vertebral Body in Kümmell’s Disease

Minimally Invasive Thoracic Spine Surgery ◽

10.1007/978-981-15-6615-8_28 ◽

2020 ◽

pp. 251-257

Author(s):

Shih Min Lee ◽

Junseok Bae

Keyword(s):

Minimally Invasive ◽

Vertebral Body ◽

Kummell’S Disease ◽

Kümmell’S Disease

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Is obesity associated with poorer outcomes in patients undergoing minimally invasive mitral valve surgery?

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa274 ◽

2020 ◽

Vol 59 (1) ◽

pp. 187-191 ◽

Cited By ~ 1

Author(s):

Firas Aljanadi ◽

Caroline Toolan ◽

Thomas Theologou ◽

Matthew Shaw ◽

Kenneth Palmer ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

High Body Mass Index ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

World Health ◽

Obese Patients ◽

Operative Outcomes ◽

Significant Difference ◽

Baseline Characteristics

Abstract OBJECTIVES High body mass index (BMI) makes minimally invasive mitral valve surgery (MIMVS) more challenging with some surgeons considering this a contraindication. We sought to determine whether this is because the outcomes are genuinely worse than those of non-obese patients. METHODS This is a retrospective cohort study of all patients undergoing MIMVS ± concomitant procedures over an 8-year period. Patients were stratified into 2 groups: BMI ≥ 30 kg/m2 and BMI ˂ 30 kg/m2, as per World Health Organization definitions. Baseline characteristics, operative and postoperative outcomes and 5-year survival were compared. RESULTS We identified 296 patients (BMI ≥30, n = 41, median 35.3, range 30–43.6; BMI <30, n = 255, median 26.2, range 17.6–29.9). The groups were well matched with regard to baseline characteristics. There was only 1 in-hospital mortality, and this was in the BMI < 30 group. There was no difference in repair rate for degenerative disease (100% vs 96.3%, P > 0.99 respectively) or operative durations [cross-clamp: 122 min interquartile range (IQR) 100–141) vs 125 min (IQR 105–146), P = 0.72, respectively]. There were only 6 conversions to sternotomy, all in non-obese patients. There was no significant difference in any other perioperative or post-operative outcomes. Using the Kaplan–Meier analysis, there was no significant difference in 5-year survival between the 2 groups (95.8% vs 95.5%, P = 0.83, respectively). CONCLUSIONS In patients having MIMVS, there is insufficient evidence to suggest that obesity affects either short- or mid-term outcomes. Obesity should therefore not be considered as a contraindication to this technique for experienced teams.

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Thoracoscopic Vertebral Body Replacement with an Expandable Cage after Ventral Spinal Canal Decompression

Operative Neurosurgery ◽

10.1227/01.neu.0000303988.57493.b6 ◽

2007 ◽

Vol 61 (suppl_5) ◽

pp. ONS317-ONS323 ◽

Cited By ~ 10

Author(s):

Brian T. Ragel ◽

Amin Amini ◽

Meic H. Schmidt

Keyword(s):

Minimally Invasive ◽

Vertebral Body ◽

Visual Information ◽

Length Of Hospital Stay ◽

Vertebral Body Replacement ◽

Minimal Access ◽

Port Placement ◽

Thoracoscopic Approach ◽

Expandable Cage ◽

Spine Pathology

Abstract Objective: Minimally invasive thoracic anterior surgery using a thoracoscopic approach has evolved to include spinal biopsy, debridement, discectomy, decompressive corpectomy, interbody fusions, and internal fixations. Minimal access techniques can potentially decrease surgical access morbidity and also reduce the time required for recovery and healing. The thoracoscopic approach for decompression, stabilization, and anterior vertebral reconstruction of thoracolumbar fractures is described. Methods: In this article and video, we discuss patient selection, surgical positioning, port placement, thoracic level localization, exposure and removal of fractured vertebral bodies, anterior vertebral column reconstruction using an expandable cage, instrumentation, and postoperative management. Results: The potential advantages of using a minimally invasive thoracoscopic approach include direct trajectory to anterior spine pathology, minimal tissue and rib retraction, and decreased postoperative pain and length of hospital stay. The associated disadvantages include the steep learning curve for the surgeon, the need to operate with two-dimensional visual information and long instruments, and the requirement that one have an experienced surgical assistant. Conclusion: Minimally invasive surgery using a thoracoscopic approach for vertebral body replacement with an expandable cage can be performed safely. Expandable cages facilitate the vertebral body reconstruction via minimal access surgery.

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Minimally Invasive Reduction and Internal Stabilization of Osteoporotic Vertebral Body Fractures (Balloon Kyphoplasty)

European Journal of Trauma ◽

10.1007/s00068-005-6305-1 ◽

2005 ◽

Vol 31 (3) ◽

pp. 280-290 ◽

Cited By ~ 1

Author(s):

Jochen 1,4 Telefon , Fax E-Mail: Hillmeier ◽

Peter J. Meeder ◽

Gerd Nöldge ◽

Christian Kasperk

Keyword(s):

Minimally Invasive ◽

Vertebral Body ◽

Balloon Kyphoplasty ◽

Vertebral Body Fractures ◽

Internal Stabilization ◽

Minimally Invasive Reduction

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Evolution of the lateral extracavitary approach to the spine

Neurosurgical FOCUS ◽

10.3171/foc.2004.16.1.13 ◽

2004 ◽

Vol 16 (1) ◽

pp. 1-3 ◽

Cited By ~ 7

Author(s):

Jason Lifshutz ◽

Zvi Lidar ◽

Dennis Maiman

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Vertebral Body ◽

Invasive Surgery ◽

Spinal Surgery ◽

Current Practice ◽

Evolutionary Change ◽

Spinal Disorders ◽

Alternative Approaches ◽

Spine Disorders

The development of alternative approaches to spine disorders marked an evolutionary change in the methods by which surgeons address diseases that affect the ventral portion of the spine. From the advent of spinal surgery until quite recently, physicians used posterior approaches almost exclusively for the treatment of all pathological processes. Surgeons subsequently became frustrated and disenchanted with outcomes of patients with anterior vertebral body disease when these procedures were applied. This sentiment is best reflected in the surgical thought related to Pott disease. In this paper, the authors chart the development of an influential approach to the spine that is designed to address these issues: the lateral extracavitary approach. They trace its origins to early precursor procedures and follow its use in current practice for the treatment of a variety of spinal disorders. They also examine its applications, role, and continued importance in the age of minimally invasive surgery.

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