Minimally invasive spine surgery in the pediatric and adolescent population: A case series

Abstract

Background:There is scant literature evaluating the indications, techniques, and outcomes of minimally invasive spine (MIS) surgery undertaken for pediatric and adolescent spine pathology. Our study attempts to evaluate the safe and effective use of MIS techniques in pediatric and adolescent patients and to appreciate the technical nuances of MIS surgery for this age group.Methods:Consecutive pediatric and adolescent patients undergoing elective MIS lumbar procedures, from 2008 to 2016, were retrospectively analyzed from the practice of a single fellowship-trained academic spinal neurosurgeon. Information was retrieved regarding procedure and disease pathology. Descriptive data was obtained including age, sex, body mass index (BMI), insurance coverage, smoking status, and co-morbidities. Outcome measures were recorded including intraoperative complications, revision surgery, and return-to-function.Results:Sixteen patients underwent 17 surgeries. The median BMI was 29.2 (range, 20.8–41.5). Age ranged from 12 to 19 years. Nearly 20% of the patients in our series were smokers. Most patients underwent discectomy, with L5-S1 being the most common level. One patient underwent direct pars defect repair and another underwent recurrent discectomy. More than 90% of the patients were complication-free at follow-up period of 6 months. One patient had a recurrent disc herniation and another had a superficial wound infection. Overall, 82.4% patients enjoyed full return to sports such as weight lifting, gymnastics, and contact sports. One patient required pain management to help alleviate ongoing pain. Another patient required a course of outpatient rehabilitation to help with a “foot drop.”Conclusion:Our series illustrates the effective application of MIS techniques among carefully selected pediatric patients. Emphasis is on using a smaller (16 mm) tubular retractor and causing minimal disruption of paraspinal osseo-tendinous structures. MIS techniques can be successfully applied to the pediatric and adolescent age group.

Minimally invasive resection of pediatric osteoid osteomas: A report of two cases

“…[ 2 , 5 , 6 ] In the pediatric spine, MIS surgery may limit tissue disruption, and postoperative dynamic instability thus reducing other longer-term deleterious consequences. [ 4 , 7 ] In this case study, two children, ages 11 and 17, benefitted from MIS tubular decompressions of T7 and C4 OO lesions, respectively. MIS tubular surgical approaches may offer adequate resection of focal spinal OO in the pediatric population and should be considered when appropriate.…”

The experience of surgical treatment of lumbar disc herniation in adolescents using annuloplasty: analysis of a small clinical series

“…Распространенность болей в спине увеличивается с возрастом, что связано с интенсивными физическими нагрузками, ношением тяжелых рюкзаков, длительным вынужденным сидячим положением и, соответственно, малоподвиж- По данным большинства авторов, оперативное лечение остеохондроза позвоночника у подростков является высокоэффективным и приводит к купированию клинической симптоматики в 83-100 % случаев. При этом имеются сообщения о неудовлетворительных отдаленных результатах традиционных и эндоскопических операций [2,7,15,16]. Неудовлетворительные результаты могут быть, в том числе, связаны с потерей высоты межпозвонкового диска в послеоперационном периоде после дискэктомии, что приводит к усилению болевого синдрома, нарушению трудоспособности, снижению качества жизни пациентов [17,18].…”

“…Стандартом оперативного лечения грыж межпозвонкового диска является микродискэктомия, которая может быть выполнена как открыто, с применением микроскопической техники, так и эндоскопически из различных доступов. Частота отличных и хороших результатов данного метода лечения у детей и подростков достигает 83-100 % [1-3, [6][7]. Тем не менее возможен рецидив грыжи диска, который выявляют у 20 % пациентов в течение нескольких лет после операции [6][7][8][9].…”

Treatment of Scoliosis with One‐Stage Posterior Pedicle Screw System by Paraspinal Intermuscular Approach: A Minimum of Two Years of Follow‐Up

“…reported the development of endoscopic approaches to the thoracic and thoracolumbar spine. Since then, minimally invasive surgery (MIS) for scoliosis has developed rapidly 5,10–12 . The MIS approach to spinal deformity is increasingly recognized as effective and safe; it reduces trauma to soft tissue, decreases intraoperative blood loss, and minimizes surgical site infections 7,13–17 .…”