Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

Park, Ji Won; Ham, Dae-Woong; Kwon, Byung Taek; Park, Sang Min; Kim, Ho-Joong; Yeom, Jin Sup

doi:10.31616/asj.2020.0384

Cited by 63 publications

(43 citation statements)

References 52 publications

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“…Minimally invasive spine surgery has become popular in recent decades with tremendous advancements in surgical techniques and technologies. It provides similar outcomes and shows lower perioperative adverse effects, and is considered a new treatment option over traditional open surgery ( 20 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

Freehand Minimally Invasive Pedicle Screw Fixation and Minimally Invasive Decompression for a Thoracic or Lumbar Vertebral Metastatic Tumor From Hepatocellular Carcinoma

Wei

Zhou

et al. 2021

Front. Surg.

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Objective: To compare freehand minimally invasive pedicle screw fixation (freehand MIPS) combined with percutaneous vertebroplasty (PVP), minimally invasive decompression, and partial tumor resection with open surgery for treatment of thoracic or lumbar vertebral metastasis of hepatocellular carcinoma (HCC) with symptoms of neurologic compression, and evaluate its feasibility, efficacy, and safety.Methods: Forty-seven patients with 1-level HCC metastatic thoracolumbar tumor and neurologic symptoms were included between February 2015 and April 2017. Among them, 21 patients underwent freehand MIPS combined with PVP, minimally invasive decompression, and partial tumor resection (group 1), while 26 patients were treated with open surgery (group 2). Duration of operation, blood loss, times of fluoroscopy, incision length, and stay in hospital were compared between the two groups. Pre- and postoperative visual analog scale (VAS) pain score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) grade, ambulatory status, and urinary continence were also recorded. The Cobb angle and central and anterior vertebral body height were measured on lateral radiographs before surgery and during follow-ups.Results: Patients in group 1 showed significantly less blood loss (195.5 ± 169.1 ml vs. 873.1 ± 317.9 ml, P = 0.000), shorter incision length (3.4 ± 0.3 vs. 13.6 ± 1.8 cm, P = 0.000), shorter median stay in hospital (4–8/6 vs. 8–17/12 days, P = 0.000), more median times of fluoroscopy (5–11/6 vs. 4–7/5 times, P = 0.000), and longer duration of operation (204.8 ± 12.1 vs. 171.0 ± 12.0 min, P = 0.000) than group 2. Though VAS significantly decreased after surgery in both groups, VAS of group 1 was significantly lower than that of group 2 immediately after surgery and during follow-ups (P < 0.05). Similar results were found in ODI. No differences in the neurological improvement and spinal stability were observed between the two groups.Conclusion: Freehand MIPS combined with PVP, minimally invasive decompression, and partial tumor resection is a safe, effective, and minimally invasive method for treating thoracolumbar metastatic tumors of HCC, with less blood loss, better pain relief, and shorter length of midline incision and stay in hospital.

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Section: Discussionmentioning

confidence: 99%

Freehand Minimally Invasive Pedicle Screw Fixation and Minimally Invasive Decompression for a Thoracic or Lumbar Vertebral Metastatic Tumor From Hepatocellular Carcinoma

Wei

Zhou

et al. 2021

Front. Surg.

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“…Several minimally invasive spine surgical techniques have been developed to achieve better clinical outcomes and reduce postoperative complications compared to conventional open procedures. Minimally invasive surgery (MIS) has been shown to reduce postoperative pain; perioperative complications including hospital stay, blood loss, and need for analgesics; and lead to earlier recovery compared to conventional open techniques 6 – 8 . Recently, MIS-lateral LIF (LLIF) has gained popularity because it can provide similar effects as ALIF using tubular retractors.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion

Kim

et al. 2021

Sci Rep

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During lateral lumbar interbody fusion (LLIF), unintended intraoperative endplate injury (IEPI) can occur and thereafter lead cage subsidence. The aim of this study was to investigate the incidence of IEPI during LLIF, and its predisposing factors. A retrospective review was conducted on consecutive patients (n = 186; mean age, 70.0 ± 7.6 years) who underwent LLIF at 372 levels. Patient’s demographic and surgical data were compared between patients with and without IEPI. Also, the radiographic data of each level were compared between intact and IEPI segments. IEPI was identified at 76 levels (20.4%) in 65 patients. The incidences of IEPI at every 100 consecutive segments were not different. When 372 segments were analyzed independently, sagittal disc angle (DA) in the extended position (4.3° ± 3.6° at IEPI segments vs. 6.4° ± 4.0° at intact segments), the difference between sagittal DA in the extended position and cage angle (− 2.2° ± 4.0° vs. 0.0° ± 3.9°), and the difference between preoperative disc height and cage height (− 5.4 mm ± 2.4 mm vs. − 4.7 mm ± 2.0 mm) were different significantly. Also, endplate sclerosis was more common at intact segments than IEPI segments (33.2% vs. 17.3%). Multivariate analysis showed that male sex (odds ratio [OR] 0.160; 95% confidence interval [CI] 0.036–0.704), endplate sclerosis (OR 3.307; 95% CI 1.450–8.480), and sagittal DA in the extended position (OR 0.674; 95% CI 0.541–0.840) were significant associated factors for IEPI. IEPI was correlated not with surgeon’s experience, but with patient factors, such as sex, preoperative disc angle, and endplate sclerosis. Careful surgical procedures should be employed for patients with these predisposing factors.

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“…However, it is full of controversy due to the complicated surgical approach and many postoperative complications [ 5 – 8 ]. With the development of spine devices, anterior minimally invasive spinal tubular technology, such as anterior lumbar interbody fusion (ALIF), oblique lateral interbody fusion (OLIF), and direct lateral interbody fusion (DLIF), which requires smaller incisions and avoids excessive approach-related injury while allowing rapid recovery [ 9 , 10 ], has become more popular in recent years. This technique is mostly used in the treatment of intervertebral discs, but is rarely used in the treatment of vertebral body fusion for spinal fractures [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Finite Element Analysis of a Novel Anterior Locking Plate for Thoracolumbar Burst Fracture

Ren

Cheng²,

et al. 2021

BioMed Research International

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Purpose. The finite element analysis method was used to explore the biomechanical stability of a novel locking plate for thoracolumbar burst fracture fusion fixation. Methods. The thoracolumbar CT imaging data from a normal volunteer was imported into finite software to build a normal model and three different simulated surgical models (the traditional double-segment fixation model A, the novel double-segment fixation model B, and the novel single-segment fixation model C). An axial pressure (500 N) and a torque (10 Nm) were exerted on the end plate of T12 to simulate activity of the spine. We recorded the range of motion (ROM) and the maximum stress value of the simulated cages and internal fixations. Results. Model A has a larger ROM in all directions than model B (flexion 5.63%, extension 38.21%, left rotation 46.51%, right rotation 39.76%, left bending 9.45%, and right bending 11.45%). Model C also has a larger ROM in all directions than model B (flexion 555.63%, extension 51.42%, left rotation 56.98%, right rotation 55.42%, left bending 65.67%, and right bending 59.47%). The maximum stress of the cage in model A is smaller than that in model B except for the extension direction (flexion 96.81%, left rotation 175.96%, right rotation 265.73%, left bending 73.73%, and right bending 171.28%). The maximum stress value of the internal fixation in model A is greater than that in model B when models move in flexion (20.23%), extension (117.43%), and left rotation (21.34%). Conclusion. The novel locking plate has a smaller structure and better performance in biomechanical stability, which may be more compatible with minimally invasive spinal tubular technology.

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Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

Cited by 63 publications

References 52 publications

Freehand Minimally Invasive Pedicle Screw Fixation and Minimally Invasive Decompression for a Thoracic or Lumbar Vertebral Metastatic Tumor From Hepatocellular Carcinoma

Freehand Minimally Invasive Pedicle Screw Fixation and Minimally Invasive Decompression for a Thoracic or Lumbar Vertebral Metastatic Tumor From Hepatocellular Carcinoma

Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion

Finite Element Analysis of a Novel Anterior Locking Plate for Thoracolumbar Burst Fracture

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