Minimally invasive spine technology and minimally invasive spine surgery: a historical review

The trend of using smaller operative corridors is seen in various surgical specialties. Neurosurgery has also recently embraced minimal access spine technique, and it has rapidly evolved over the past 2 decades. There has been a progression from needle access, small incisions with adaptation of the microscope, and automated percutaneous procedures to endoscopically and laparoscopically assisted procedures. More recently, new muscle-sparing technology has come into use with tubular access. This has now been adapted to the percutaneous placement of spinal instrumentation, including intervertebral spacers, rods, pedicle screws, facet screws, nucleus replacement devices, and artificial discs. New technologies involving hybrid procedures for the treatment of complex spine trauma are now on the horizon. Surgical corridors have been developed utilizing the interspinous space for X-STOP placement to treat lumbar stenosis in a minimally invasive fashion. The direct lateral retroperitoneal corridor has allowed for minimally invasive access to the anterior spine. In this report the authors present a chronological, historical perspective of minimal access spine technique and minimally invasive technologies in the lumbar, thoracic, and cervical spine from 1967 through 2009. Due to a low rate of complications, minimal soft tissue trauma, and reduced blood loss, more spine procedures are being performed in this manner. Spine surgery now entails shorter hospital stays and often is carried out on an outpatient basis. With education, training, and further research, more of our traditional open surgical management will be augmented or replaced by these technologies and approaches in the future.

Download Full-text

Navigated Spinal Robotics in Minimally Invasive Spine Surgery, With Preoperative and Intraoperative Workflows: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa095 ◽

2020 ◽

Vol 19 (4) ◽

pp. E422-E422

Author(s):

Martin H Pham ◽

Joseph A Osorio ◽

Ronald A Lehman

Keyword(s):

Minimally Invasive ◽

Ct Scan ◽

Spine Surgery ◽

Degenerative Spondylolisthesis ◽

Spinal Instrumentation ◽

Pedicle Screws ◽

Transforaminal Lumbar Interbody Fusion ◽

Minimally Invasive Spine Surgery ◽

Patient Consent ◽

Minimally Invasive Spine

Abstract The use of robotic guidance for spinal instrumentation has become promising for its ability to offer the advantages of precision, accuracy, and reproducibility. However, the utilization and adoption of robotic platforms for spine surgery remain limited, especially in comparison to other surgical fields. We present here a case of a 52-yr-old man with a grade 1 L4-5 degenerative spondylolisthesis causing severe claudication and radiculopathy who subsequently underwent a minimally invasive L4-5 transforaminal lumbar interbody fusion with navigated spinal robotic assistance (Mazor X Stealth Edition, Mazor Robotics Ltd, Caesarea, Israel). This platform allows for planning and registration via (1) a preoperative thin-cut computed tomography (CT) scan, or (2) an intraoperative CT “scan-and-plan” method. We show here the preoperative CT method that we use in the majority of our patients. To our knowledge, this is the first video demonstrating the preoperative software and intraoperative surgical registration and instrument workflow of navigated spinal robotic guidance using the Mazor X Stealth Edition for the insertion of pedicle screws in a minimally invasive spine surgery procedure. There is no identifying information in this video. Patient consent was obtained for the surgical procedure and for publishing of the material included in the video.

Download Full-text

Neuronavigation in minimally invasive spine surgery

Neurosurgical FOCUS ◽

10.3171/2013.5.focus13150 ◽

2013 ◽

Vol 35 (2) ◽

pp. E12 ◽

Cited By ~ 35

Author(s):

Ziev B. Moses ◽

Rory R. Mayer ◽

Benjamin A. Strickland ◽

Ryan M. Kretzer ◽

Jean-Paul Wolinsky ◽

...

Keyword(s):

Minimally Invasive ◽

Spine Surgery ◽

Image Guidance ◽

Intraoperative Imaging ◽

Minimally Invasive Spine Surgery ◽

Screw Placement ◽

Minimal Access ◽

3D Navigation ◽

Endoscopic Techniques ◽

Minimally Invasive Spine

Object Parallel advancements in image guidance technology and minimal access techniques continue to push the frontiers of minimally invasive spine surgery (MISS). While traditional intraoperative imaging remains widely used, newer platforms, such as 3D-fluoroscopy, cone-beam CT, and intraoperative CT/MRI, have enabled safer, more accurate instrumentation placement with less radiation exposure to the surgeon. The goal of this work is to provide a review of the current uses of advanced image guidance in MISS. Methods The authors searched PubMed for relevant articles concerning MISS, with particular attention to the use of image-guidance platforms. Pertinent studies published in English were further compiled and characterized into relevant analyses of MISS of the cervical, thoracic, and lumbosacral regions. Results Fifty-two studies were included for review. These describe the use of the iso-C system for 3D navigation during C1–2 transarticular screw placement, the use of endoscopic techniques in the cervical spine, and the role of navigation guidance at the occipital-cervical junction. The authors discuss the evolving literature concerning neuronavigation during pedicle screw placement in the thoracic and lumbar spine in the setting of infection, trauma, and deformity surgery and review the use of image guidance in transsacral approaches. Conclusions Refinements in image-guidance technologies and minimal access techniques have converged on spinal pathology, affording patients the ability to undergo safe, accurate operations without the associated morbidities of conventional approaches. While percutaneous transpedicular screw placement is among the most common procedures to benefit from navigation, other areas of spine surgery can benefit from advances in neuronavigation and further growth in the field of image-guided MISS is anticipated.

Download Full-text

Placement of percutaneous pedicle screws without imaging guidance

Neurosurgical FOCUS ◽

10.3171/foc.2006.20.3.4 ◽

2006 ◽

Vol 20 (3) ◽

pp. 1-6 ◽

Cited By ~ 29

Author(s):

Ciaran J. Powers ◽

Vinod K. Podichetty ◽

Robert E. Isaacs

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Pedicle Screw ◽

Spine Surgery ◽

Spinal Canal ◽

Pedicle Screws ◽

Degenerative Disease ◽

Imaging Guidance ◽

Intraoperative Fluoroscopy ◽

Minimally Invasive Spine

✓ Pedicle screw (PS) instrumentation provides an exceptionally rigid construct to promote fusion in cases of spinal trauma and degenerative disease. Although the safety of traditional open techniques for PS placement has been well documented, there are no large series in the literature in which the safety of percutaneously placed PSs has been examined. Because the advantages of minimally invasive spine surgery are becoming more widely recognized, especially in regard to the lessening of morbidity caused by pain and blood loss, there will be a greater demand for spine surgeons to place PSs percutaneously. During a 2-year period, the authors placed 287 PSs percutaneously with the aid of intraoperative fluoroscopy. Only one of these screws was later found to have breached the spinal canal, yielding a breach rate of 0.35% for percutaneously placed PSs (one of 287).

Download Full-text