RSS-Feed abonnieren
DOI: 10.4103/2277-9167.131995
Minimally invasive spine surgery: Hurdles to be crossed
Verantwortlicher Herausgeber dieser Rubrik:
Publikationsverlauf
Publikationsdatum:
18. Januar 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00028728/201401/lookinside/thumbnails/10-4103-2277-9167-131995-1.jpg)
Abstract
MISS as a concept is noble and all surgeons need to address and minimize the surgical morbidity for better results. However, we need to be cautions and not fall prey into accepting that minimally invasive spine surgery can be done only when certain metal access systems are used. Minimally invasive spine surgery (MISS) has come a long way since the description of endoscopic discectomy in 1997 and minimally invasive TLIF (mTLIF) in 2003. Today there is credible evidence (though not level-I) that MISS has comparable results to open spine surgery with the advantage of early postoperative recovery and decreased blood loss and infection rates. However, apart from decreasing the muscle trauma and decreasing the muscle dissection during multilevel open spinal instrumentation, there has been little contribution to address the other morbidity parameters like operative time , blood loss , access to decompression and atraumatic neural tissue handling with the existing MISS technologies. Since all these parameters contribute to a greater degree than posterior muscle trauma for the overall surgical morbidity, we as surgeons need to introspect before we accept the concept of minimally invasive spine surgery being reduced to surgeries performed with a few tubular retractors. A spine surgeon needs to constantly improve his skills and techniques so that he can minimize blood loss, minimize traumatic neural tissue handling and minimizing operative time without compromising on the surgical goals. These measures actually contribute far more, to decrease the morbidity than approach related muscle damage alone. Minimally invasine spine surgery , though has come a long way, needs to provide technical solutions to minimize all the morbidity parameters involved in spine surgery, before it can replace most of the open spine surgeries, as in the case of laparoscopic surgery or arthroscopic surgery.
-
References
- 1 Foley KT, Smith MM, Rampersaud YR. Microendoscopic approach to far-lateral lumbar disc herniation. Neurosurg Focus 1999; 7: e5
- 2 Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976) 2003; 28 (15) Suppl S26-S35 Review
- 3 Oppenheimer JH, DeCastro I, McDonnell DE. Minimally invasive spine technology and minimally invasive spine surgery: A historical review. Neurosurg Focus 2009; 27: E9
- 4 Thongtrangan I, Le H, Park J, Kim DH. Minimally invasive spinal surgery: A historical perspective. Neurosurg Focus 2004; 16: E13
- 5 Wu RH, Fraser JF, Hartl R. Minimal access versus open transforaminal lumbar interbody fusion: Meta-analysis of fusion rates. Spine (Phila Pa 1976) 2010; 35: 2273-2281
- 6 O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine 2009; 11: 471-476
- 7 Mirza SK, Deyo RA, Heagerty PJ, Konodi MA, Lee LA, Turner JA. et al Development of an index to characterize the “invasiveness” of spine surgery: Validation by comparison to blood loss and operative time. Spine (Phila Pa 1976) 2008; 33: 2651-2661
- 8 Cizik AM, Lee MJ, Martin BI, Bransford RJ, Bellabarba C, Chapman JR. et al Using the spine surgical invasiveness index to identify risk of surgical site infection: A multivariate analysis. J Bone Joint Surg Am 2012; 94: 335-342
- 9 Fan S, Hu Z, Zhao F, Zhao X, Huang Y, Fang X. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: Minimally invasive procedure versus conventional open approach. Eur Spine J 2010; 19: 316-324
- 10 Kim CW. Scientific basis of minimally invasive spine surgery: Prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976) 2010; 35: S281-S286
- 11 Tsutsumimoto T, Shimogata M, Ohta H, Misawa H. Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: Comparison of paraspinal muscle damage and slip reduction. Spine (Phila Pa 1976) 2009; 34: 1923-1928
- 12 Muramatsu K, Hachiya Y, Morita C. Postoperative magnetic resonance imaging of lumbar disc herniation: Comparison of microendoscopic discectomy and Love’s method. Spine (Phila Pa 1976) 2001; 26: 1599-1605
- 13 Spaner SJ, Warnock GL. A brief history of endoscopy, laparoscopy, and laparoscopic surgery. J Laparoendosc Adv Surg Tech A 1997; 7: 369-373
- 14 US Markets for Minimally Invasive Spine Technologies, 2013. Available from: http://www.mrg.net/Products.and.Services/Syndicated.Report.aspx?r=RPUS20MI12#sthash.Zb1dycG1.dpuf.
- 15 Seng C, Siddiqui MA, Wong KP, Zhang K, Yeo W, Tan SB. et al Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: A matched-pair comparison study. Spine (Phila Pa 1976) 2013; 38: 2049-2055
- 16 Fourney DR, Dettori JR, Norvell DC, Dekutoski MB. Does minimal access tubular assisted spine surgery increase or decrease complications in spinal decompression or fusion?. Spine (Phila Pa 1976) 2010; 35 (09) Suppl S57-S65
- 17 Sclafani JA, Kim CW. Complications associated with the initial learning curve of minimally invasive spine surgery: A systematic review. Clin Orthop Relat Res 2014;Feb 8 [Epub ahead of print].
- 18 Ahn Y, Kim CH, Lee JH, Lee SH, Kim JS. Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: A prospective study. Spine (Phila Pa 1976) 2013; 38: 617-625
- 19 Park Y, Ha JW. Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine (Phila Pa 1976) 2007; 32: 537-543
- 20 Lee KH, Yeo W, Soeharno H, Yue WM. Learning curve of a complex surgical technique: Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). J Spinal Disord Tech 2014; Oct 27 (07) E234-E240 doi: 10.1097/BSD.0000000000000089.
- 21 Arts MP, Brand R, van den Akker ME, Koes BW, Bartels RH, Peul WC. et al Tubular diskectomy vs conventional microdiskectomy for sciatica: A randomized controlled trial. JAMA 2009; 302: 149-158
- 22 Wang MY, Cummock MD, Yu Y, Trivedi RA. An analysis of the differences in the acute hospitalization charges following minimally invasive versus open posterior lumbar interbody fusion. J Neurosurg Spine 2010; 12: 694-699