Minimally invasive spinal surgery: a historical perspective

Thongtrangan, Issada; Le, Hoang; Park, Jon; Kim, Daniel H.

doi:10.3171/foc.2004.16.1.14

Cited by 93 publications

(55 citation statements)

References 88 publications

(74 reference statements)

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“…59 To create a more homogenous patient cohort, studies involving the following procedures were excluded: interbody fusion, transperitoneal lumbar microdiscectomy, corpectomy, revision surgery, and lumbar microdiscectomy spanning more than one vertebral level. We included studies in which lumbar microdiscectomy was performed for degenerative indications and excluded those in which lumbar discectomy was performed to treat infection and tumor pathological processes.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Shriver¹,

Xie

Tye³

et al. 2015

FOC

125

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OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.

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Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Shriver¹,

Xie

Tye³

et al. 2015

FOC

125

View full text Add to dashboard Cite

show abstract

“…Similar to stabilization procedures of the thoracolumbar spine, which have been proposed to reduce access-related morbidity as muscular denervation, atrophy, length of hospital stay, blood loss and postoperative pain [16,21,22], minimally invasive procedures for posterior cervical instrumentation represent the next logical step. Therefore, several authors reported minimally invasive posterior procedures for stabilization and decompression of the cervical spine [5,8,33,40,45]; however, the long-term benefit on clinical outcome remains to be proven. In this study, the feasibility and accuracy of percutaneous CPS placement using conventional fluoroscopy and three-dimensional fluoroscopy are presented and limitations as well as indications of this technique are discussed.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to stabilization procedures of the thoracolumbar spine with the objective to reduce access-related morbidity as muscular denervation and atrophy, length of hospital stay and blood loss [10,16,21,22,38,44], minimally invasive procedures for cervical instrumentation represent the next step to reduce accessrelated muscular trauma. Therefore, several authors reported minimally invasive posterior procedures for stabilization and decompression of the cervical spine [8,33,40,45]. However, this topic has not extensively investigated yet.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous instrumentation of the cervical and cervico-thoracic spine using pedicle screws: preliminary clinical results and analysis of accuracy

et al. 2011

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The pedicle screw instrumentation represents the most rigid construct of the cervical and cervicothoracic spine and in spite of the risks to neurovascular structures clinical relevant complications do not occur frequently. The steep angles of the cervical pedicles result in a wide surgical exposure with extensive muscular trauma. The objective of this study was the evaluation of the accuracy of cervical pedicle screw insertion through a minimally invasive technique to reduce access-related muscular trauma. Therefore, percutaneous transpedicular instrumentation of the cervical and cervicothoracic spine was performed in 15 patients using fluoroscopy. All instrumentations from C2 to Th4 were inserted bilaterally through 2 to 3-cm skin and fascia incisions even in multilevel procedures and the rods were placed by blunt insertion through the incision. Thin-cut CT scan was used postoperatively to analyze pedicle violations. 76.4% of 72 screws were placed accurately. Most pedicle perforations were seen laterally towards the vertebral artery. Critical breaches [2 mm or narrowing of the transversal foramen occurred in 12.5% of screws; however, no revision surgery for screw displacement was needed in the absence of clinical symptoms. No conversion from percutaneous to open surgery was necessary. It was concluded that percutaneous transpedicular instrumentation of the cervical spine is a surgically demanding technique and should be reserved for experienced spine surgeons. The indications are limited to instrumentation-only procedures or in combination with anterior treatment, but with the potential to minimize access-related morbidity.

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“…In order to prevent these complications, many authors have performed and popularized alternative less invasive surgical techniques. Nowadays, minimal access procedures are increasingly gaining popularity in spine surgery [15,33,45] but their use is poorly described in the treatment of cervical spine tumors [46]. The purpose of the present paper is to illustrate our experience with these minimally invasive approaches for the treatment of cervical schwannomas.…”

Section: Introductionmentioning

confidence: 99%

Less invasive approaches for the treatment of cervical schwannomas: our experience

et al. 2011

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Purpose The purpose of our paper is to illustrate our experience with minimally invasive approaches for the treatment of cervical schwannomas. Moreover, a brief review of the literature was conducted. Methods All data regarding patients treated for cervical schwannomas were retrospectively revised. Site, size and extension of the lesions and preoperative neurological status were obtained through re-examination of neuroimaging and clinical records. Postoperative clinical examinations and radiological images were available for all patients. The clinical course was documented using the visual analog scale (VAS), Karnofsky score (KPS) and the Klekamp-Samii score system. Results Sixteen patients harboring cervical schwannomas were treated from 2003 to 2009. Hemilaminectomy was performed in eight cases, subtotal hemilaminectomy in four cases, interlaminar fenestration in two cases, osteoplastic hemilaminotomy and laminoplasty in one case each. Postoperative neuroimaging revealed complete removal of the lesion and no signs of spinal instability. At discharge, neurological improvement was observed in 14 patients and all patients demonstrated reduction of VAS score and improvement of KPS and Klekamp-Samii's score. Conclusions Minimal access procedures are increasingly gaining popularity but their use is poorly described in the treatment of cervical tumors. Less invasive approaches may effectively be used instead of traditional laminectomy in the treatment of cervical tumors, especially schwannomas, providing less iatrogenic traumatism and preventing postsurgical spinal instability. Modern neuroimaging allows adequate preoperative planning and microsurgical techniques provide adequate execution of the surgical act. The procedure has to be tailored case by case considering the specific lesional features and the individual anatomical situation.

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Minimally invasive spinal surgery: a historical perspective

Cited by 93 publications

References 88 publications

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Percutaneous instrumentation of the cervical and cervico-thoracic spine using pedicle screws: preliminary clinical results and analysis of accuracy

Less invasive approaches for the treatment of cervical schwannomas: our experience

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