Review: Complications of Minimally Invasive Spinal Surgery

Perez-Cruet, Mick J.; Fessler, Richard G.; Perin, Noel I.

doi:10.1097/00006123-200211002-00005

Cited by 73 publications

(91 citation statements)

References 73 publications

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“…Specialized retraction systems, computer-assisted navigation technologies, and focused cadaveric training courses have been developed to decrease the MIS learning curve [28]. However, surgeons who adopt these techniques must be prepared for a higher complication rate and prolonged operative times during the initial experience with MIS procedures [20].…”

Section: Introductionmentioning

confidence: 99%

Complications Associated With the Initial Learning Curve of Minimally Invasive Spine Surgery: A Systematic Review

Sclafani

Kim

2014

Clinical Orthopaedics &Amp; Related Research

198

167

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Background There is an inherently difficult learning curve associated with minimally invasive surgical (MIS) approaches to spinal decompression and fusion. The association between complication rate and the learning curve remains unclear. Questions/purposes We performed a systematic review for articles that evaluated the learning curves of MIS procedures for the spine, defined as the change in frequency of complications and length of surgical time as case number increased, for five types of MIS for the spine. Methods We conducted a systematic review in the PubMed database using the terms ''minimally invasive spine surgery AND complications AND learning curve'' followed by a manual citation review of included manuscripts. Clinical outcome and learning curve metrics were categorized for analysis by surgical procedure (MIS lumbar decompression procedures, MIS transforaminal lumbar interbody fusion, percutaneous pedicle screw insertion, laparoscopic anterior lumbar interbody fusion, and MIS cervical procedures). As the most consistent parameters used to evaluate the learning curve were procedure time and complication rate as a function of chronologic case number, our analysis focused on these. The search strategy identified 15 original studies that included 966 minimally invasive procedures. Learning curve parameters were correlated to chronologic procedure number in 14 of these studies. Results The most common learning curve complication for decompressive procedures was durotomy. For fusion procedures, the most common complications were implant malposition, neural injury, and nonunion. The overall postoperative complication rate was 11% (109 of 966 cases). The learning curve was overcome for operative time and complications as a function of case numbers in 20 to 30 consecutive cases for most techniques discussed within this review. Conclusions The quantitative assessment of the procedural learning curve for MIS techniques for the spine remains challenging because the MIS techniques have different learning curves and because they have not been assessed in a consistent manner across studies. Complication rates may be underestimated by the studies we identified because surgeons tend to select patients carefully during the early learning curve period. The field of MIS would benefit from a standardization of study design and collected parameters in future learning curve investigations.

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Section: Introductionmentioning

confidence: 99%

Complications Associated With the Initial Learning Curve of Minimally Invasive Spine Surgery: A Systematic Review

Sclafani

Kim

2014

Clinical Orthopaedics &Amp; Related Research

198

167

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“…Although this approach may be advantageous for multi-level involvement, other approaches have been considered for a single level. An alternate approach would be to do an anterior and subsequently a posterior approach for the vertebral resection, or as reported by Fourney et al, a simultaneous anterior-posterior approach [9]. Yet again, these are extensive surgeries and when indicated, are good alternatives.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic assisted en bloc resection of a spine tumor

et al. 2010

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Spine tumors are fairly common and the management is through a multimodality approach. Lesions of the thoracic and lumbar vertebrae have been treated with such extensive anterior and/or posterior approaches. The authors present a case of a 56-year-old lady with solitary T11 metastases from colonic carcinoma and a case of a 43-year-old lady with T5-T6 high-grade osteogenic sarcoma. The treatment consists of a wide vertebrectomy by posterior approach, after anterior release and sub-pleural dissection using a thoracoscopic approach. A thoracoscopic assisted anterior approach could reduce the duration and the morbidity of a vertebrectomy without affecting oncological management.

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“…Peroneal nerve palsy can occur if the nerve is compressed over the fibular head. 21 Regarding complications related to endoscope placement, injury to the lung parenchyma and other vessels may occur, 1,21,22 as the initial port is placed blindly. Lung adhesions may be the cause of lung injury during port placement and postoperative air leaks.…”

Section: Complicationsmentioning

confidence: 99%

“…Endoscopic instruments and retractors placed in the chest cavity can cause injury to the lung parenchyma and to large vessels in the chest cavity, leading to air leaks postoperatively and excessive blood loss intra-operatively. 12,[21][22][23] Likely bleeding sources include epidural veins, tumour feeding vessels, and sometimes intercostal vessels (especially when corpectomy is involved).…”

Section: Complicationsmentioning

confidence: 99%