Minimally Invasive Procedures for Disorders of the Lumbar Spine

Abstract

In the past decade, there has been a substantial increase in interest in minimally invasive procedures in all areas of medicine, particularly for spinal disorders. Some of these techniques represent notable advances in spinal care and have major roles in the care of patients with back-related symptoms. Other techniques appear to offer no benefit and in some cases may be less effective than conventional treatments. Percutaneous lumbar diskectomy techniques hold considerable promise; however, lumbar microdiskectomy is the gold standard for surgical treatment of lumbar disk protrusion with radiculopathy. Intradiskal electrothermal therapy is emerging as a useful option for selected patients with intractable mechanical back pain whose only other option historically has been a spinal fusion. Percutaneous fusion techniques are in their infancy and may prove to be beneficial for these patients as well. Percutaneous vertebral augmentation, including vertebroplasty and kyphoplasty, has become the treatment of choice for many patients with intractable back pain secondary to vertebral insufficiency fractures. Spinal injections are important for evaluating and managing spinal pain and can be extremely useful diagnostically and therapeutically. This multidisciplinary review outlines the status of these procedures and offers suggestions for their use in patient care.

Sacral kyphoplasty for relieving pain caused by sacral hemangioma

“…These breaks are associated with loss of pulmonary function, gastrointestinal complications (early satiety, and therefore malnutrition), complications related to immobilization (such as deep venous thrombosis), and increased mortality. [1][2][3][4][5][6][7][8] Kyphoplasty is a minimally invasive method that is used to treat painful osteoporotic vertebral body compression fractures, osteolytic metastasis and hemangiomas to provide vertebral augmentation. [3][4][5][6] In this technique, a balloon is used to reduce the fracture and to create a void in the cancellous bone.…”

“…[9][10][11][12][13][14] Kyphoplasty has been used from the midthoracic region down to the L5 level. [3][4][5][6][7][8] However, experience with these methods in the sacrum is very limited. [15][16][17] In this paper, we describe a patient who was debilitated by chronic renal failure due to renal cell cancer, and had intractable pain due to an aggressive hemangioma in the first sacral vertebra.…”

History of spinal surgery: one neurosurgeon's perspective

“…There is a trend toward minimization in surgical procedures, including percutaneous discectomy, intradiscal electrothermal coagulation, percutaneous fusion, vertebroplasty, kyphoplasty, discography, zygapophysial blocks, and epidural blocks for the treatment of lumbar pain syndromes. 6 Kelly 12 warns us about the "quick fix" and the "bake, fake, and massage" approach to spinal disorders, noting the need for controlled studies to verify the efficacy of new procedures. A healthy skepticism needs to be kept in mind for the individual surgeon when new and unproven ventures are proposed.…”

The importance of loading the periphery of the vertebral endplate

“…Therefore, positioning the MPIs in the central region of the endplate is typically a less complicated procedure than ensuring that the endplate periphery is loaded, making this a common scenario (5). Supplemental fixation, either anteriorly, posteriorly or both is often used to provide the required stability (6,8).…”