scholarly journals Minimally invasive spinal surgery: a historical perspective

2004 ◽  
Vol 16 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Issada Thongtrangan ◽  
Hoang Le ◽  
Jon Park ◽  
Daniel H. Kim

The concept of minimally invasive spinal surgery embodies the goal of achieving clinical outcomes comparable to those of conventional open surgery, while minimizing the risk of iatrogenic injury that may be incurred during the exposure process. The development of microscopy, laser technology, endoscopy, and video and image guidance systems provided the foundation on which minimally invasive spinal surgery is based. Minimally invasive treatments have been undertaken in all areas of the spinal axis since the 20th century. Lumbar disc disease has been treated using chemonucleolysis, percutaneous discectomy, laser discectomy, intradiscal thermoablation, and minimally invasive microdiscectomy techniques. The initial use of thoracoscopy for thoracic discs and tumor biopsies has expanded to include deformity correction, sympathectomy, vertebrectomy with reconstruction and instrumentation, and resection of paraspinal neurogenic tumors. Laparoscopic techniques, such as those used for appendectomy or cholecystectomy by general surgeons, have evolved into procedures performed by spinal surgeons for anterior lumbar discectomy and fusion. Image-guided systems have been adapted to facilitate pedicle screw placement with increased accuracy. Over the past decade, minimally invasive treatment of cervical spinal disorders has become feasible by applying technologies similar to those developed for the thoracic and lumbar spine. Endoscope-assisted transoral surgery, cervical lam-inectomy, discectomy, and foraminotomy all represent the continual evolution of minimally invasive spinal surgery. Further improvement in optics and imaging resources, development of biological agents, and introduction of instrumentation systems designed for minimally invasive procedures will inevitably lead to further applications in minimally invasive spine surgery.

Neurosurgery ◽  
2002 ◽  
Vol 51 (suppl_2) ◽  
pp. S2-137-S2-145 ◽  
Author(s):  
Joseph C. Maroon

Abstract OBJECTIVE The purpose of this study was to evaluate the various minimally invasive procedures available for the treatment of lumbar disc disease. METHODS A review of the literature, as well as my personal experience with minimally invasive approaches to the lumbar discs, was performed. This review included the percutaneous and open surgical approaches currently available and used for the treatment of lumbar disc disease. RESULTS The primary minimally invasive procedures for the treatment of lumbar disc disease include the following: 1) chemonucleolysis, introduced by Lyman Smith in 1964; 2) percutaneous manual nucleotomy, introduced by Hijikata in 1975; 3) microdiscectomy, first performed by Yaşargil in 1968; 4) automated percutaneous lumbar discectomy, introduced by Onik in 1984; 5) laser discectomy, first performed by Ascher and Choy in 1987; 6) endoscopic discectomy, first used by Schreiber and Suezawa in 1986 and improved by Mayer, Brock, and Mathews; 7) microendoscopic discectomy, introduced by Smith and Foley in 1995; and 8) intradiscal electrothermy, first reported by Saal and Saal in 2000. CONCLUSION Although all percutaneous techniques have been reported to yield high success rates, to date no studies have demonstrated any of these to be superior to microsurgical discectomy, which continues to be regarded as the standard with which all other techniques must be compared.


2019 ◽  
Vol 10 (4) ◽  
pp. 31-35
Author(s):  
Sohail Amir ◽  
Bilal Khan ◽  
Aurangzeb ◽  
Khaleeq-Uz-Zaman

ABSTRACT:OBJECTIVE: The objective of this study is to determine the incidence of dural tear in lumbar spine surgeries and associated risk factors. MATERIAL AND METHODS: In this descriptive cross sectional study, 117 Patients were studied in the department of Neurosurgery, Naseer Teaching Hospital Peshawar from February 2013 to December 2016. All patients with either gender or age who needed spinal surgery for lumbar disc disease, spinal stenosis, and re-do surgery were included in study while those with trauma, tumor and infection were excluded. Data was collected regarding the age of patients, co-morbid conditions, lumbar spine disease, level of involvement, type of operation, occurrence of dural tear, site of dural tear and complications were recorded on a predesigned proforma. Data was analyzed using SPSS version 20.0. RESULTS: Out of 117 patients 63(53.8%) were male and 54(46.1%) were female. Male to female ratio was 1.2:1. In our study the age of patient ranged from 16 to 80 years with mean age 38 + 2.34 years Dural tear occurred in 15(12.8%) of patients, among these 5 (4.2%) dural tear in lumbar disc prolapsed , 8(6.8%) in spinal stenosis and 2 (1.7%) in surgery for recurrent disc disease. The complication rate was 19(16.2%), among these the most common complication was cerebrospinal fluid leak (CSF) in 7(5.9%), delayed wound healing in 5(4.2%), discitis in 4(3.4%) and others in 3(2.5%) of patients. CONCLUSION: Dural tear (DT) is not uncommon complication during spinal surgery and represent a serious challenge for both surgeon and patients. Female, obese, older age, re-do surgery are the major risk factor for dural tear.


2021 ◽  
Vol 12 (01) ◽  
pp. 159-164
Author(s):  
Vinu V. Gopal

Abstract Objective To identify the current management modalities practiced by neurosurgeons in India for degenerative lumbar disc disease. Materials and Methods Survey questionnaires were prepared in Google forms. It covered the following aspects of managing the lumbar disc pathology: (1) Demographic, institutional details, experience of surgeons, (2)choice of surgical procedures, (3) use of endoscopy and minimally invasive techniques, and (4) pre- and postoperative care. Responses obtained were entered in SPSS datasheet and analyzed. Results Of the 300 surveys sent, 80 were returned and response rate was 26.6%. But four surveys were highly incomplete and were discarded from the analysis. So, the study content is from the analysis of practices of 76 spinal surgeons working in different parts of the country. Majority of the spine surgeons (n = 70) were neurosurgeons, while 6 were orthopaedic surgeons. Fifty-four were from urban area, 12 from semiurban area, and 10 from rural area. Forty-seven spine surgeons practiced in a teaching hospital. Total 73.6% of spine surgeons opted initial medical management. Sixty-three percent preferred microlumbar discectomy (MLD) and only eight neurosurgeons preferred minimally invasive techniques. None of the respondents used in situ fusion. Fifty-three percent of spine surgeons preferred early mobilization (first postoperative day). Fifty-nine percent preferred to follow-up patients clinically and opted for magnetic resonance imaging only when recurrence or infection was suspected. The institutional nature (government teaching, government nonteaching, private teaching, and private nonteaching) and location of the hospital (urban/semiurban/rural) were found to be influencing the preferred surgical technique, trial of medical management, or postoperative care and complications. Considerable practice variations exist for medical and perioperative management. Conclusion The preferred treatment of choice of majority was MLD, although laminectomy and discectomy were still used by many. Consensus lacks in the operative, perioperative, and postoperative management of degenerative disc disease. Present survey points toward the importance of making management guidelines for this common spinal surgical entity.


Sign in / Sign up

Export Citation Format

Share Document