Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes

2010 ◽  
Vol 28 (3) ◽  
pp. E9 ◽  
Author(s):  
Michael Y. Wang ◽  
Praveen V. Mummaneni
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Interbody Fusion ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Minimally Invasive Surgical ◽  
Csf Leakage ◽  
The Mean

Object Adult degenerative scoliosis can be a cause of intractable pain, decreased mobility, and reduced quality of life. Surgical correction of this problem frequently leads to substantial clinical improvement, but advanced age, medical comorbidities, osteoporosis, and the rigidity of the spine result in high surgical complication rates. Minimally invasive surgery is being applied to this patient population in an effort to reduce the high complication rates associated with adult deformity surgery. Methods A retrospective study of 23 patients was undertaken to assess the clinical and radiographic results with minimally invasive surgery for adult thoracolumbar deformity surgery. All patients underwent a lateral interbody fusion followed by posterior percutaneous screw fixation and possible minimally invasive surgical transforaminal lumbar interbody fusion if fusion near the lumbosacral junction was necessary. A mean of 3.7 intersegmental levels were treated (range 2–7 levels). The mean follow-up was 13.4 months. Results The mean preoperative Cobb angle was 31.4°, and it was corrected to 11.5° at follow-up. The mean blood loss was 477 ml, and the operative time was 401 minutes. The mean visual analog scale score improvement for axial pain was 3.96. Clear evidence of fusion was seen on radiographs at 84 of 86 treated levels, with no interbody pseudarthroses. Complications included 2 returns to the operating room, one for CSF leakage and the other for hardware pullout. There were no wound infections, pneumonia, deep venous thrombosis, or new neurological deficits. However, of all patients, 30.4% experienced new thigh numbness, dysesthesias, pain, or weakness, and in one patient these new symptoms were persistent. Conclusions The minimally invasive surgical treatment of adult deformities is a promising method for reducing surgical morbidity. Numerous challenges exist, as the surgical technique does not yet allow for all correction maneuvers used in open surgery. However, as the techniques are advanced, the applicability of minimally invasive surgery for this population will likely be expanded and will afford the opportunity for reduced complications.

scholarly journals Minimally invasive anterior lumbar interbody fusion for adult degenerative scoliosis with 1 or 2 dislocated levels

2015 ◽  
Vol 23 (6) ◽  
pp. 739-746 ◽  
Author(s):  
Charles-Henri Flouzat-Lachaniette ◽  
Louis Ratte ◽  
Alexandre Poignard ◽  
Jean-Charles Auregan ◽  
Steffen Queinnec ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Leg Pain ◽  
Lumbar Interbody Fusion ◽  
Degenerative Scoliosis ◽  
Surgical Morbidity ◽  
Adult Degenerative Scoliosis ◽  
The Mean

OBJECT Frequent complications of posterolateral instrumented fusion have been reported after treatment of degenerative scoliosis in elderly patients. Considering that in some cases, most of the symptomatology of adult degenerative scoliosis (ADS) is a consequence of the segmental instability at the dislocated level, the use of minimally invasive anterior lumbar interbody fusion (ALIF) to manage symptoms can be advocated to reduce surgical morbidity. The purpose of this study was to evaluate the midterm outcomes of 1- or 2-level minimally invasive ALIFs in ADS patients with 1- or 2-level dislocations. METHODS A total of 47 patients (average age 64 years; range 43–80 years) with 1- or 2-level ALIF performed for ADS (64 levels) in a single institution were included in the study. An independent spine surgeon retrospectively reviewed all the patients’ medical records and radiographs to assess operative data and surgery-related complications. Clinical outcome was reported using the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for lumbar and leg pain. Intraoperative data and complications were collected. Fusion and risk for adjacent-level degeneration were assessed. RESULTS The mean follow-up duration was 3 years (range 1–10 years). ODI, and back and leg pain VAS scores were significantly improved at last follow-up. A majority of patients (74%) had a statistically significant improvement in their ODI score of more than 20 points at latest follow-up and 1 had a worsening of his disability. The mean operating time was 166 minutes (range 70–355 minutes). The mean estimated blood loss was 410 ml (range 50–1700 ml). Six (5 major and 1 minor) surgical complications (12.7% of patients) and 13 (2 major and 11 minor) medical complications (27.7% of patients) occurred without death or wound infection. Fusion was achieved in 46 of 47 patients. Surgery resulted in a slight but significant decrease of the Cobb angle, and improved the pelvic parameters and lumbar lordosis, but had no effect on the global sagittal balance. At latest follow-up, 9 patients (19.1%) developed adjacent-segment disease at a mean of 2 years’ delay from the index surgery; 4 were symptomatic but treated medically, and none required iterative surgery. CONCLUSIONS Single- or 2-level minimally invasive fusion through a minimally invasive anterior approach in some selected cases of ADS produced a good functional outcome with a high fusion rate. They were associated with a significantly lower rate of complications in this study than the historical control.

Prospective multicenter study of minimally invasive surgery for the treatment of adult spinal deformity

2021 ◽  
pp. 1-8
Author(s):  
Gregory M. Mundis ◽  
Jakub Godzik ◽  
Paul Park ◽  
Kai-Ming Fu ◽  
Stacie Tran ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Multicenter Study ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Lumbar Interbody Fusion ◽  
Inclusion Criteria ◽  
Prospective Multicenter Study ◽  
The Mean

OBJECTIVE Traditional surgery for adult spinal deformity (ASD) is effective but may result in exposure-related morbidity. Minimally invasive surgery (MIS) can potentially minimize this morbidity; however, high-level evidence is lacking. This study presents the first prospective multicenter investigation of MIS approaches for ASD. METHODS A prospective multicenter study was conducted. Inclusion criteria were age ≥ 18 years, with at least one of the following radiographic criteria: coronal Cobb (CC) angle ≥ 20°, sagittal vertical axis (SVA) > 5 cm, pelvic tilt (PT) > 25°, and thoracic kyphosis > 60°. Additional inclusion criteria were circumferential MIS, including interbody fusion (transforaminal lumbar interbody fusion [TLIF], lateral lumbar interbody fusion [LLIF], or anterior lumbar interbody fusion [ALIF]) with percutaneous posterior fixation on a minimum of 4 intervertebral levels. Radiographic and clinical outcomes (visual analog scale [VAS], Oswestry Disability Index [ODI], and Scoliosis Research Society–22 [SRS-22]) were collected preoperatively and at 12 months postoperatively; preoperative and postoperative values were compared using paired Student t-tests. RESULTS Seventy-five patients with a minimum 1-year follow-up were identified (75 of 111; 67.6%). The mean ± SD age was 68.8 ± 9.0 years, and 48 patients (64%) were female. Patients underwent a mean of 6.7 ± 2.9 levels of fusion with LLIF (85%), ALIF (55%), and TLIF (9%); the mean estimated blood loss was 547.6 ± 567.2 mL, and the mean length of stay was 7.0 ± 3.7 days. Significant improvements were observed in ODI (−19 ± 12.9, p < 0.001), SRS-22 (0.8 ± 0.66, p < 0.001), VAS back (−4.3 ± 2.8, p < 0.001), and VAS leg (−3.0 ± 3.2, p < 0.001) scores. Significant decreases in SVA (−26.4 ± 53.6 mm; p < 0.001), pelvic incidence–lumbar lordosis (−11.3° ± 14.9°, p < 0.001), and CC angle (−12.1° ± 11.8°, p < 0.001) were also observed. Complications occurred in 39 patients (52%); 11 patients (15%) experienced major complications, and 16 patients (21%) required reoperation. CONCLUSIONS MIS approaches for ASD resulted in meaningful symptomatic improvement. The complication rates were similar to historic norms, with a fairly high reoperation rate at 1 year. Longer follow-up will be necessary to evaluate the durability of this approach in the treatment of ASD.

Comparison of two minimally invasive surgery strategies to treat adult spinal deformity

2015 ◽  
Vol 22 (4) ◽  
pp. 374-380 ◽  
Author(s):  
Paul Park ◽  
Michael Y. Wang ◽  
Virginie Lafage ◽  
Stacie Nguyen ◽  
John Ziewacz ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Cobb Angle ◽  
Invasive Surgery ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Significant Difference ◽  
Vas Scores ◽  
The Mean

OBJECT Minimally invasive surgery (MIS) techniques are becoming a more common means of treating adult spinal deformity (ASD). The aim of this study was to compare the hybrid (HYB) surgical approach, involving minimally invasive lateral interbody fusion with open posterior instrumented fusion, to the circumferential MIS (cMIS) approach to treat ASD. METHODS The authors performed a retrospective, multicenter study utilizing data collected in 105 patients with ASD who were treated via MIS techniques. Criteria for inclusion were age older than 45 years, coronal Cobb angle greater than 20°, and a minimum of 1 year of follow-up. Patients were stratified into 2 groups: HYB (n = 62) and cMIS (n = 43). RESULTS The mean age was 60.7 years in the HYB group and 61.0 years in the cMIS group (p = 0.910). A mean of 3.6 interbody fusions were performed in the HYB group compared with a mean of 4.0 interbody fusions in the cMIS group (p = 0.086). Posterior fusion involved a mean of 6.9 levels in the HYB group and a mean of 5.1 levels in the cMIS group (p = 0.003). The mean follow-up was 31.3 months for the HYB group and 38.3 months for the cMIS group. The mean Oswestry Disability Index (ODI) score improved by 30.6 and 25.7, and the mean visual analog scale (VAS) scores for back/leg pain improved by 2.4/2.5 and 3.8/4.2 for the HYB and cMIS groups, respectively. There was no significant difference between groups with regard to ODI or VAS scores. For the HYB group, the lumbar coronal Cobb angle decreased by 13.5°, lumbar lordosis (LL) increased by 8.2°, sagittal vertical axis (SVA) decreased by 2.2 mm, and LL–pelvic incidence (LL-PI) mismatch decreased by 8.6°. For the cMIS group, the lumbar coronal Cobb angle decreased by 10.3°, LL improved by 3.0°, SVA increased by 2.1 mm, and LL-PI decreased by 2.2°. There were no significant differences in these radiographic parameters between groups. The complication rate, however, was higher in the HYB group (55%) than in the cMIS group (33%) (p = 0.024). CONCLUSIONS Both HYB and cMIS approaches resulted in clinical improvement, as evidenced by decreased ODI and VAS pain scores. While there was no significant difference in degree of radiographic correction between groups, the HYB group had greater absolute improvement in degree of lumbar coronal Cobb angle correction, increased LL, decreased SVA, and decreased LL-PI. The complication rate, however, was higher with the HYB approach than with the cMIS approach.

scholarly journals A synopsis of current practices in minimally invasive surgery for adult spinal deformity

2017 ◽  
Vol 3 (4) ◽  
pp. 643
Author(s):  
Aniruddh V. Agrawal ◽  
Vinod A. Agrawal ◽  
Adit A. Singhal ◽  
Adit Maniar
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Spine Surgery ◽  
Invasive Surgery ◽  
Spinal Deformity ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Minimally Invasive Spine Surgery ◽  
Complication Rates ◽  
Minimally Invasive Spine

<p>To provide a comprehensive summary of the status, indications and developments in the use of minimally invasive surgery in the field of adult spinal deformity. This study was performed by expert review of literature which has been published and is indexed on PubMed. The most appropriate and recent articles were selected to obtain a consolidation of information and knowledge on use and benefits of minimally invasive surgery in adult spinal deformity. Various MIS techniques have been developed to perform the complex ASD surgeries. These include the transforaminal lateral interbody fusion (TLIF), percutaneous segmental fixation as well as the lateral body interbody fusion (LLIF). It is important for a surgeon to obtain a holistic view of current literature and recommended guidelines on the procedures available for ASD surgeries. Overall, minimally invasive spine surgery has resulted in less use of pain medicine, less blood loss, lower infection rates, less requirement for intensive care, less hospitalization, reduction in physiologic stress, reduction in complication rates, reduction in muscle atrophy and preservation of normal motion with fusion rates being as high as 80-95%. More articles consolidating the vast literature on minimally invasive spine surgery need to be published to allow a surgeon to effectively weight the benefits and drawbacks of it. More research needs to be performed to compare the efficacy of sub-types of minimally invasive spine surgery.</p>

scholarly journals Sliding distal metatarsal minimally invasive osteotomy (S-DMMO) for correction of bunionette deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0050
Author(s):  
Jorge Del Vecchio ◽  
Mauricio Ghioldi ◽  
Lucas Chemes ◽  
Miki Dalmau-Pastor
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Weight Bearing ◽  
Osteotomy Site ◽  
Surgical Trauma ◽  
Aofas Score ◽  
Reliable Technique ◽  
The Mean

Category: Midfoot/Forefoot Introduction/Purpose: Bunionette refers to painful lateral prominence at the fifth metatarsal head. For refractory cases, surgical intervention is indicated. Several operative treatments have been used to treat this deformity. Open surgery has been associated with wound healing problems, symptomatic hardware and infection. Recently, there has been a growing interest in the u utilization of minimally invasive surgery (MIS) essentially because of its inherent advantages, including less surgical trauma and preservation of blood supply. This has a direct impact in the patient leading to lower morbidity rates and faster recovery with immediate weight bearing. The purpose of the study was to describe both clinical and radiographic medium-term results of a sliding distal metatarsal minimally invasive osteotomy (S-DMMO) for correction of bunionette deformity. Methods: This is a retrospective review of patients who underwent S-DMMO to treat symptomatic bunionette deformity. We studied 46 feet from 36 patients, who were treated between Feb 2012 and March 2016. The surgeries were performed by two surgeons trained in minimally invasive surgery or percutaneous. The average follow-up was 49,74 years (33-70). The average age was 48 years (25-76). Radiographic measurements and clinical assessment were obtained preoperatively, six weeks postoperatively, and at final follow-up. Radiographic assessment includes evaluation of the fifth metatarsophalangeal angle, 4-5 intermetatarsal angles and medial osteotomy displacement (mm). Clinical evaluation included the lesser toe American Orthopaedic Foot and Ankle Society (AOFAS) score. The subjective satisfaction rate was measured using the Coughlin Score. Results: The mean 4-5 intermetatarsal angles was reduced from 10,88° to 7,1° and the fifth metatarsophalangeal angle was reduced from 14,7° to 6,47° postoperatively. Functional and clinical outcome, as assessed by a postoperative lesser toe AOFAS score showed good and excellent results (80-100 points) in all feet. The mean AOFAS score improved from 62,81pre-operatively to 92,42 points at final follow-up. Consolidation of the osteotomy site was achieved in all cases with a periosteal callus. According to the Coughlin classification system patient’s subjective assessments were: excellent (32 feet), good (12 feet) and fair (2 feet). No mayor complications were seen. One patient required reoperation (resection of symptomatic residual fifth metatarsal). Other complications found were: 1 superficial infection and 1 wound dehiscence. Conclusion: Our results showed that S-DMMO to be a safe and reliable technique for surgeons trained in MIS surgery. The mentioned is a novel, extrarticular and epiphasary technique that doesn´t need to be stabilized with osteosynthesis and provides a definite advantage over other techniques described. It is necessary to emphasize the importance of prevention of complications by a careful preoperative planning, a correct surgical procedure (specific instruments are required) and a strict postoperative control.

Clinical and radiological outcomes of minimally-invasive surgery for adolescent idiopathic scoliosis at a minimum two years’ follow-up

2020 ◽  
Vol 102-B (4) ◽  
pp. 506-512 ◽  
Author(s):  
Charlotte de Bodman ◽  
Alexandre Ansorge ◽  
Anne Tabard-Fougère ◽  
Nicolas Amirghasemi ◽  
Romain Dayer
Keyword(s):  
Minimally Invasive Surgery ◽  
Adolescent Idiopathic Scoliosis ◽  
Minimally Invasive ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Invasive Surgery ◽  
Complication Rate ◽  
Posterior Approach ◽  
The Mean

Aims The direct posterior approach with subperiosteal dissection of the paraspinal muscles from the vertebrae is considered to be the standard approach for the surgical treatment of adolescent idiopathic scoliosis (AIS). We investigated whether or not a minimally-invasive surgery (MIS) technique could offer improved results. Methods Consecutive AIS patients treated with an MIS technique at two tertiary centres from June 2013 to March 2016 were retrospectively included. Preoperative patient deformity characteristics, perioperative parameters, power of deformity correction, and complications were studied. A total of 93 patients were included. The outcome of the first 25 patients and the latter 68 were compared as part of our safety analysis to examine the effect of the learning curve. Results In the first 25 cases, with a mean follow-up of 5.6 years (standard deviation (SD) 0.4), the mean preoperative major Cobb angle was 57.6° (SD 9.8°) and significantly corrected to mean 15.4° (SD 5.6°, 73% curve correction). The mean preoperative T5-T12 was 26.2 (SD 12.8) and significantly increased to mean 32.9 (SD 8.3). Both frontal and sagittal plane correction was conserved two years after surgery. The rate of perioperative complications was 12% and three further complications occurred (three deep delayed infection). In the latter cases, 68 patients were included with a mean follow-up time of three years (SD 0.6). The mean preoperative major Cobb angle was 58.4° (SD 9.2°) and significantly corrected to mean 20.4° (SD 7.3°).The mean preoperative T5-T12 kyphosis was 26.6° (SD 12.8°) and was significantly increased to mean 31.4° (SD 8.3°). Both frontal and sagittal correction was conserved two years after surgery. The perioperative (30 day) complication rate was 1.4%. Two (2.9%) additional complications occurred in two patients. Conclusion MIS for AIS is associated with a significant correction of spine deformity in the frontal and sagittal planes, together with low estimated blood loss and short length of stay. The perioperative complication rate seems to be lower compared with the standard open technique based on the literature data. The longer-term safety of MIS for AIS needs to be documented with a larger cohort and compared with the standard posterior approach. Cite this article: Bone Joint J 2020;102-B(4):506–512.

Kinematics of a Fully-Decoupled Remote Center-of-Motion Parallel Manipulator for Minimally Invasive Surgery

2012 ◽  
Vol 6 (2) ◽  
Author(s):  
Chin-Hsing Kuo ◽  
Jian S. Dai
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Inverse Kinematics ◽  
Parallel Manipulator ◽  
Degrees Of Freedom ◽  
Surgical Instruments ◽  
End Effector ◽  
Minimally Invasive Surgical ◽  
Inverse Kinematics Problem

A crucial design challenge in minimally invasive surgical (MIS) robots is the provision of a fully decoupled four degrees-of-freedom (4-DOF) remote center-of-motion (RCM) for surgical instruments. In this paper, we present a new parallel manipulator that can generate a 4-DOF RCM over its end-effector and these four DOFs are fully decoupled, i.e., each of them can be independently controlled by one corresponding actuated joint. First, we revisit the remote center-of-motion for MIS robots and introduce a projective displacement representation for coping with this special kinematics. Next, we present the proposed new parallel manipulator structure and study its geometry and motion decouplebility. Accordingly, we solve the inverse kinematics problem by taking the advantage of motion decouplebility. Then, via the screw system approach, we carry out the Jacobian analysis for the manipulator, by which the singular configurations are identified. Finally, we analyze the reachable and collision-free workspaces of the proposed manipulator and conclude the feasibility of this manipulator for the application in minimally invasive surgery.

Design of Double-Light Shadowless Lifting Retractor

2012 ◽  
Vol 499 ◽  
pp. 248-252
Author(s):  
Jun Sun ◽  
Bo Xiang ◽  
Ping Zhou ◽  
Rui Wang
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Single Port ◽  
Abdominal Cavity ◽  
Surgical Instrument ◽  
Design Requirement ◽  
Gasless Laparoscopy ◽  
Minimally Invasive Surgical ◽  
Patented Product

The single-port gasless laparoscopic surgical instrument is an international leading patented product in minimally invasive surgery. This paper first describes the composition and the usage of the shadowless retractor of the single-port gasless laparoscopy minimally invasive surgical instrument. Aim to meet the specific requirement arise in the minimally invasive surgery for the animal abdominal cavity, we first improve the existing shadowless lifting retractor. Then, this paper proposes and designs the double-light shadowless lifting retractor. The test has shown the designed double-light shadowless lifting retractor has satisfied the design requirement. The practical tests have been done and shown the viability and effectiveness of the proposed design approach.

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