The Current State of Minimally Invasive Approaches to Adult Spinal Deformity

Lovecchio, Francis; Qureshi, Sheeraz A.

doi:10.1007/s12178-019-09570-6

Cited by 20 publications

(13 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, the same anatomical limitations that apply to generating lordosis through a TLIF (i.e., intact anterior longitudinal ligament, dependence on resection of posterior elements) also apply to LLIF, creating a "ceiling effect" on how much lordosis the cage lordotic angle is able to induce. 8 The clinical relevance of these constraints has been borne out in the adult deformity literature, where the limitations of multilevel LLIF without anterior column realignment in restoring lumbar lordosis are well described. 6,29,30 If surgeons wish to increase lordosis through LLIF or TLIF, they should not rely on an increased cage lordotic angle; rather, they must plan to release the restricting anatomical structures (adjunct steps that can still be performed in an MIS manner) and focus on positioning the cage in the anterior half of the disc space.…”

Section: Discussionmentioning

confidence: 99%

“…7 A key difference between MIS and open or hybrid approaches relates to resection of the posterior elements. 8 MIS techniques being utilized to treat degenerative lumbar conditions focus on minimal bony and ligamentous resection for insertion of the interbody cage. While the maintenance of these structures may be associated with reduced postoperative pain, 9,10 it likely restricts the amount of lordosis that can be generated at the operative level.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Does interbody cage lordosis impact actual segmental lordosis achieved in minimally invasive lumbar spine fusion?

Lovecchio

Vaishnav

Steinhaus

et al. 2020

Neurosurgical Focus

Self Cite

View full text Add to dashboard Cite

OBJECTIVEIn an effort to prevent loss of segmental lordosis (SL) with minimally invasive interbody fusions, manufacturers have increased the amount of lordosis that is built into interbody cages. However, the relationship between cage lordotic angle and actual SL achieved intraoperatively remains unclear. The purpose of this study was to determine if the lordotic angle manufactured into an interbody cage impacts the change in SL during minimally invasive surgery (MIS) for lumbar interbody fusion (LIF) done for degenerative pathology.METHODSThe authors performed a retrospective review of a single-surgeon database of adult patients who underwent primary LIF between April 2017 and December 2018. Procedures were performed for 1–2-level lumbar degenerative disease using contemporary MIS techniques, including transforaminal LIF (TLIF), lateral LIF (LLIF), and anterior LIF (ALIF). Surgical levels were classified on lateral radiographs based on the cage lordotic angle (6°–8°, 10°–12°, and 15°–20°) and the position of the cage in the disc space (anterior vs posterior). Change in SL was the primary outcome of interest. Subgroup analyses of the cage lordotic angle within each surgical approach were also conducted.RESULTSA total of 116 surgical levels in 98 patients were included. Surgical approaches included TLIF (56.1%), LLIF (32.7%), and ALIF (11.2%). There were no differences in SL gained by cage lordotic angle (2.7° SL gain with 6°–8° cages, 1.6° with 10°–12° cages, and 3.4° with 15°–20° cages, p = 0.581). Subgroup analysis of LLIF showed increased SL with 15° cages only (p = 0.002). The change in SL was highest after ALIF (average increase 9.8° in SL vs 1.8° in TLIF vs 1.8° in LLIF, p < 0.001). Anterior position of the cage in the disc space was also associated with a significantly greater gain in SL (4.2° vs −0.3°, p = 0.001), and was the only factor independently correlated with SL gain (p = 0.016).CONCLUSIONSCompared with cage lordotic angle, cage position and approach play larger roles in the generation of SL in 1–2-level MIS for lumbar degenerative disease.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Does interbody cage lordosis impact actual segmental lordosis achieved in minimally invasive lumbar spine fusion?

Lovecchio

Vaishnav

Steinhaus

et al. 2020

Neurosurgical Focus

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the past two decades, ASD surgery has made rapid progress in parallel with the advancement of intraoperative imaging, image guidance, and robotics. Surgical treatment had limited applicability to ASD patients before, however, recently ASD patients may now benefit from less invasive treatments with outcomes that demonstrate an improved the quality of life (33). Nevertheless, there are some challenging problems remaining, notably that approximately 70% of patients experienced at least one complication postoperatively, and approximately 30% required at least one revision procedure (34).…”

Section: Future Perspectives Of Intraoperative Image Guidance In Asd Surgerymentioning

confidence: 99%

Intraoperative image guidance for the surgical treatment of adult spinal deformity

Boddapati¹,

Lombardi²,

Urakawa³

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

Operative management of adult spinal deformity (ASD) has been increasing in recent years secondary to an aging society. The advance of intraoperative image guidance, such as the development of navigation and robotics systems has contributed to the growth and safety of ASD surgery. Currently, intraoperative image guidance is mainly used for pedicle screw placement and the evaluation of alignment correction in ASD surgery. Though it is expected that the use of navigation and robotics would result in increasing pedicle screw accuracy as reported in other spine surgeries, there are no well-powered studies specifically focusing on ASD surgery. Currently, deformity correction relies heavily on preoperative planning, however, a few studies have shown the possibility that intraoperative image modalities may accurately predict postoperative spinopelvic parameters. Future developments of intraoperative image guidance are needed to overcome the remaining challenges in ASD surgery such as radiation exposure to patient and surgeon. More novel imaging modalities may result in evolution in ASD surgery. Overall there is a paucity of literature focusing on intraoperative image guidance in ASD surgery, therefore, further studies are warranted to assess the efficacy of intraoperative image guidance in ASD surgery. This narrative review sought to provide the current role and future perspectives of intraoperative image guidance focusing on ASD surgery.

show abstract

“…The first robotic system cleared for use in spine surgery by the US Food and Drug Administration (FDA) was the SpineAssist (Mazor Robotics LTD, Caesarea, Israel) in 2004 [13,16]. The SpineAssist was replaced by the Mazor Renaissance (Mazor Surgical Technologies Ltd, Caesarea, Israel) in 2011, and the first reports of the use of RASS in pediatric spinal deformity utilized this system [13,16,18,28]. This system was a mechanically driven bone-mounted system with a robotic manipulator, allowing for 6 degrees of freedom, attached to a bone-mounting frame on the patient's spine.…”

Section: Introductionmentioning

confidence: 99%

Less Invasive Pediatric Spinal Deformity Surgery: The Case for Robotic-Assisted Placement of Pedicle Screws

et al. 2021

View full text Add to dashboard Cite

Introduction: Pediatric spinal deformity involves a complex 3-dimensional (3D) deformity that increases the risk of pedicle screw placement due to the close proximity of neurovascular structures. To increase screw accuracy, improve patient safety, and minimize surgical complications, the placement of pedicle screws is evolving from freehand techniques to computer-assisted navigation and to the introduction of robotic-assisted placement. Purpose: The aim of this review was to review the current literature on the use of robotic navigation in pediatric spinal deformity surgery to provide both an error analysis of these techniques and to provide recommendations to ensure its safe application. Methods: A narrative review was conducted in April 2021 using the MEDLINE (PubMed) database. Studies were included if they were peer-reviewed retrospective or prospective studies, included pediatric patients, included a primary diagnosis of pediatric spine deformity, utilized robotic-assisted spinal surgery techniques, and reported thoracic or lumbar pedicle screw breach rates or pedicle screw malpositioning. Results: In the few studies published on the use of robotic techniques in pediatric spinal deformity surgery, several found associations between the technology and increased rates of screw placement accuracy, reduced rates of breach, and minimal complications. All were retrospective studies. Conclusions: Current literature is of a low level of evidence; nonetheless, the findings suggest the accuracy and safety of robotic-assisted spinal surgery in pediatric pedicle screw placement. The introduction of robotics may drive further advances in less invasive pediatric spinal deformity surgery. Further study is warranted.

show abstract

The Current State of Minimally Invasive Approaches to Adult Spinal Deformity

Cited by 20 publications

References 45 publications

Does interbody cage lordosis impact actual segmental lordosis achieved in minimally invasive lumbar spine fusion?

Does interbody cage lordosis impact actual segmental lordosis achieved in minimally invasive lumbar spine fusion?

Intraoperative image guidance for the surgical treatment of adult spinal deformity

Less Invasive Pediatric Spinal Deformity Surgery: The Case for Robotic-Assisted Placement of Pedicle Screws

Contact Info

Product

Resources

About