Recent Updates on Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

Choi, Jun-Young; Park, Sang-Min; Kim, Ho-Joong; Yeom, Jin Sup

doi:10.31616/asj.2022.0436

Cited by 21 publications

(14 citation statements)

References 57 publications

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“…In MISS, where the surgeon cannot directly observe the patient’s internal anatomical structure, the implementation of AR technology may solve this problem [ 13 , 53 ]. Currently, in navigation spine surgery, there is a shift from performing surgery on two-dimensional monitors toward the adoption of AR.…”

Section: Discussionmentioning

confidence: 99%

Current Trends in Artificial Intelligence-Assisted Spine Surgery: A Systematic Review

Liawrungrueang,

Cho,

Sarasombath

et al. 2024

Asian Spine J

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This systematic review summarizes existing evidence and outlines the benefits of artificial intelligence-assisted spine surgery. The popularity of artificial intelligence has grown significantly, demonstrating its benefits in computer-assisted surgery and advancements in spinal treatment. This study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a set of reporting guidelines specifically designed for systematic reviews and meta-analyses. The search strategy used Medical Subject Headings (MeSH) terms, including “MeSH (Artificial intelligence),” “Spine” AND “Spinal” filters, in the last 10 years, and English— from January 1, 2013, to October 31, 2023. In total, 442 articles fulfilled the first screening criteria. A detailed analysis of those articles identified 220 that matched the criteria, of which 11 were considered appropriate for this analysis after applying the complete inclusion and exclusion criteria. In total, 11 studies met the eligibility criteria. Analysis of these studies revealed the types of artificial intelligence-assisted spine surgery. No evidence suggests the superiority of assisted spine surgery with or without artificial intelligence in terms of outcomes. In terms of feasibility, accuracy, safety, and facilitating lower patient radiation exposure compared with standard fluoroscopic guidance, artificial intelligence-assisted spine surgery produced satisfactory and superior outcomes. The incorporation of artificial intelligence with augmented and virtual reality appears promising, with the potential to enhance surgeon proficiency and overall surgical safety.

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Section: Discussionmentioning

confidence: 99%

Current Trends in Artificial Intelligence-Assisted Spine Surgery: A Systematic Review

Liawrungrueang,

Cho,

Sarasombath

et al. 2024

Asian Spine J

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“…Since the introduction of percutaneous endoscopic lumbar discectomy (PELD) by Kambin et al in the mid-1990s [ 12 , 13 ], endoscopic spine surgery has creatively evolved, with its surgical indication being expanded to the lumbar spine and the cervical and thoracic spines [ 2 ]. PE differs from the open microscopic or micro-endoscopic technique in the way the surgeon’s hand works.…”

Section: Discussionmentioning

confidence: 99%

“…The evolvement of spinal endoscopic platforms and techniques has enabled surgeons to perform spinal decompression under indirect visualisation with more limited surgical exposure, thereby moving the point of anatomical perspective into the body of patients. This improvement reduces inpatient care requirements, lowers surgical expenditures, reduces pain, and expedites functional recovery [ 1 , 2 ]. However, spinal endoscopy requires surgical experience and training to improve the surgical performance of surgeons who are familiar with direct surgical visualisation using a surgical microscope.…”

Section: Introductionmentioning

confidence: 99%

Learning curve for biportal endoscopic posterior cervical foraminotomy determined using the cumulative summation test

Kang

Park

et al. 2023

J Orthop Surg Res

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Background Learning curves describe the rate of performance improvements corresponding to the surgeon’s caseload, followed by a plateau where limited further improvements are observed. This study aimed to determine the learning curve for biportal full-endoscopic posterior cervical foraminotomy (BE-PCF) for the unilateral cervical foraminal disc. Methods The learning curve was evaluated using a learning curve cumulative summation test (LC-CUSUM). The goal for the operation time was set to 78 min, which is the mean operation time (mOT) of percutaneous full-endoscopic posterior cervical foraminotomy (PE-PCF) performed by a senior surgeon. Moreover, clinical outcomes and post-operative complications were compared between the early and late learning periods 1 year post-operatively. Results This study enrolled the first 50 patients who underwent single-level BE-PCF, performed by a single surgeon. The LC-CUSUM signalled competency for surgery at the 20th operation, indicating that sufficient evidence was obtained to prove that the surgeon was competent. The mOT was 71.29 ± 11.69 min in BE-PCF, 71.84 ± 12.61 min in the early learning period, and 67.83 ± 10.31 min in the late learning period (p = 0.254). There was no statistical difference in clinical outcomes, visual analogue scale scores, and neck disability index between both periods (p > 0.05). Four complications were recorded throughout the whole period, with three in the early period and one in the late period (p = 0.285). Conclusion Our study shows that BE-PCF has a learning curve of 20 caseloads to achieve 90% proficiency, and it significantly reduces the operation time based on the performance of a senior surgeon proficient in PE-PCF.

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“…Likewise, spinal surgery using an endoscope is likely to have a bigger market in the future; some spine surgeons are already performing fusion surgery using an endoscope. 22 23 24 25 26 27 28 29 30) Spinal surgeons who are not yet trained in endoscopic surgery need to prepare in advance, so they do not fall behind the trend.…”

Section: Discussionmentioning

confidence: 99%

A Beginner’s Perspective on Biportal Endoscopic Spine Surgery in Single-Level Lumbar Decompression: A Comparative Study with a Microscopic Surgery

2023

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Background The application of biportal endoscopic spinal surgery (BESS) in spine surgery is increasing. However, the clinical results of related studies have been inconsistent. In this study, the perioperative and clinical outcomes of two techniques in single-level lumbar decompression surgery were compared using the perspective of a spine surgeon experienced in microscopic surgery but inexperienced in BESS. Methods This is a retrospective study performed with prospectively collected data. From April 2019, 50 consecutive patients who underwent a single-level lumbar decompression surgery with BESS were evaluated. Additionally, the data of 150 consecutive patients who underwent the same microscopic surgery before April 2019 were collected. We performed 1 : 1 ratio propensity score matching for these two groups to adjust for baseline variables. The postoperative patient-reported outcome measures included the Oswestry Disability Index (ODI) and numeric rating scale for the back and leg preoperatively and at 6 months after surgery. The laboratory data (C-reactive protein [CRP, mg/L] and hemoglobin [Hb, g/dL]) were measured preoperatively and 3 times (1, 2, and 3 or 4 days) postoperatively. In these periods, the peak and lowest CRP and Hb concentrations were evaluated. The perioperative outcomes, operation time (from skin incision to dressing), length of hospital stay, drainage (for 24 hours after surgery), and surgery-related complications were also evaluated. Results Forty-seven patients (27 men and 20 women) were included in each group. The postoperative 6-month ODI was significantly lower in the BESS group than in the microscope group (6.90 ± 5.98 vs. 11.54 ± 9.70). The peak CRP concentration (16.63 ± 19.41 vs. 42.40 ± 37.73, p < 0.001) and CRP increment (peak CRP minus preoperative CRP, 14.69 ± 19.47 vs. 40.71 ± 37.32, p < 0.001) were significantly higher in the microscope group. Operation time (83.72 ± 35.71 vs. 70.27 ± 23.24, p = 0.047) was significantly longer in the BESS group. Surgery-related complications were found in 6 and 3 cases in the BESS group (3 revisions, 2 dural tears, and 1 conversion to open surgery) and microscope group (2 revisions and 1 hematoma), respectively. Conclusions BESS as a new technique resulted in satisfying short-term outcomes. It was a well-tolerated option for surgical treatment of single-level lumbar degenerative disease. The relatively high incidence of recurrence at the index level and incidental dural tears should be considered for surgeons new to BESS; however, these were manageable complications.

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Recent Updates on Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

Cited by 21 publications

References 57 publications

Current Trends in Artificial Intelligence-Assisted Spine Surgery: A Systematic Review

Current Trends in Artificial Intelligence-Assisted Spine Surgery: A Systematic Review

Learning curve for biportal endoscopic posterior cervical foraminotomy determined using the cumulative summation test

A Beginner’s Perspective on Biportal Endoscopic Spine Surgery in Single-Level Lumbar Decompression: A Comparative Study with a Microscopic Surgery

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