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Garríguez-Pérez D, Vargas Jiménez A, Luque Pérez R, Carrascosa Granada A, Oñate Martínez-Olascoaga D, Pérez González JL, Domínguez Esteban I, Marco F. [Translated article] The role of minimally invasive spine surgery in the treatment of vertebral metastasis: A narrative review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:S458-S462. [PMID: 37543359 DOI: 10.1016/j.recot.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/03/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Spinal metastases are a very common problem which dramatically affects the quality of life of cancer patients. The objective of this review is to address the issue of how minimally invasive surgery can play an important role in treating this pathology. METHODS A literature review was performed, searching in the Google Scholar, PubMed, Scopus and Cochrane databases. Relevant and quality papers published within the last 10 years were included in the review. RESULTS After screening the 2184 initially identified registers, a total of 24 articles were included for review. CONCLUSION Minimally invasive spine surgery is specially convenient for fragile cancer patients with spinal metastases, because of its reduced comorbidity compared to conventional open surgery. Technological advances in surgery, such as navigation and robotics, improve accuracy and safety in this technique.
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Affiliation(s)
- D Garríguez-Pérez
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain.
| | - A Vargas Jiménez
- Servicio de Neurocirugía, Hospital Clínico San Carlos, Madrid, Spain
| | - R Luque Pérez
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Cirugía, Universidad Complutense, Madrid, Spain
| | | | - D Oñate Martínez-Olascoaga
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
| | - J L Pérez González
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
| | - I Domínguez Esteban
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
| | - F Marco
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Cirugía, Universidad Complutense, Madrid, Spain
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Garríguez-Pérez D, Vargas Jiménez A, Luque Pérez R, Carrascosa Granada A, Oñate Martínez-Olascoaga D, Pérez González JL, Domínguez Esteban I, Marco F. The role of minimally invasive spine surgery in the treatment of vertebral metastasis: A narrative review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:458-462. [PMID: 37031861 DOI: 10.1016/j.recot.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Spinal metastases are a very common problem which dramatically affects the quality of life of cancer patients. The objective of this review is to address the issue of how minimally invasive surgery can play an important role in treating this pathology. METHODS A literature review was performed, searching in the Google Scholar, PubMed, Scopus and Cochrane databases. Relevant and quality papers published within the last 10 years were included in the review. RESULTS After screening the 2184 initially identified registers, a total of 24 articles were included for review. CONCLUSION Minimally invasive spine surgery is specially convenient for fragile cancer patients with spinal metastases, because of its reduced comorbidity compared to conventional open surgery. Technological advances in surgery, such as navigation and robotics, improve accuracy and safety in this technique.
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Affiliation(s)
- D Garríguez-Pérez
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
| | - A Vargas Jiménez
- Servicio de Neurocirugía, Hospital Clínico San Carlos, Madrid, España
| | - R Luque Pérez
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España; Departamento de Cirugía, Universidad Complutense, Madrid, España
| | | | - D Oñate Martínez-Olascoaga
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - J L Pérez González
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - I Domínguez Esteban
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - F Marco
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España; Departamento de Cirugía, Universidad Complutense, Madrid, España
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Wang YP, Qin SL, Yang S, Xu YF, Han PF. Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis: A systematic review and updated meta‑analysis. Exp Ther Med 2023; 26:309. [PMID: 37273751 PMCID: PMC10236128 DOI: 10.3892/etm.2023.12008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/24/2023] [Indexed: 06/06/2023] Open
Abstract
The incidence of lumbar spinal stenosis is increasing annually, and with an ever-aging population and longer life expectancies, this trend will further continue. It is hoped that a more effective treatment can be found so that the patients can be relieved of their pain. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of unilateral biportal endoscopic surgery (UBE) and microscopic decompression surgery (MD) for the treatment of lumbar spinal stenosis. A literature search of related studies published until April 2022 was performed using PubMed, EMBASE, Cochrane Library, Web of Science, ClinicalTrials.gov, Google Scholar, China National Knowledge Infrastructure (CNKI), and other databases. After filtering of references, 12 eligible studies were identified that compared UBE with MD as a treatment for lumbar spinal stenosis. Data were extracted and analysed using R. A total of 12 articles (four randomized controlled and eight cohort studies) were included, with a total of 1,067 patients: 250 men and 249 women in the UBE group and 290 men and 278 women in the MD group. The meta-analysis showed that the mean intraoperative blood loss in the UBE group [standardized mean difference (SMD)=-2.10, 95% confidence interval (CI) (-3.97, -0.23), P=0.03] was lower than that in the MD group. The postoperative Visual analogue scale (VAS) score for back pain [SMD=-0.52, 95% CI (-0.76, -0.27), P<0.01], leg pain [SMD=-0.30, 95% CI (-0.51, -0.08), P<0.01], postoperative Oswestry disability index [(ODI); SMD=-0.25, 95% CI (-0.48, -0.03), P=0.03], and postoperative C-reactive protein [(CRP); odds ratio (OR)=-0.92, 95% CI (-1.80, 0.03), P=0.04] were lower than those in the MD group. Complications (OR=0.60, 95% CI (0.37, 0.98), P=0.04) and hospital stay (SMD=-1.84, 95% CI (-2.85, 0.83), P <0.01] were also lesser in the UBE group than in the MD group. UBE was preferable to that in the MD group according to the modified MacNab score [OR=2.28, 95% CI (1.28, 4.06), P<0.01]. No significant differences were observed in the operation times between the groups. UBE surgery was found to be a better option for the treatment of lumbar spinal stenosis than MD surgery.
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Affiliation(s)
- Yue-Peng Wang
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
- Department of Orthopaedics, Pinggu Hospital of Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 101200, P.R. China
| | - Shi-Lei Qin
- Department of Orthopaedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
| | - Su Yang
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yun-Feng Xu
- Department of Orthopaedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
| | - Peng-Fei Han
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
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Flynn SC, Eli IM, Ghogawala Z, Yew AY. Minimally Invasive Surgery for Spinal Metastasis: A Review. World Neurosurg 2021; 159:e32-e39. [PMID: 34861449 DOI: 10.1016/j.wneu.2021.11.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Minimally invasive surgery (MIS) techniques have advanced the treatment of metastatic diseases to the spine. The objective of this review is to describe clinical outcomes, benefits, and complications of these techniques. METHODS All relevant clinical studies describing the role of MIS, computer-assisted navigation (CAN), robot-assisted (RA) procedures, and laser interstitial thermal therapy (LITT) in the treatment of metastatic spine diseases were identified from PubMed, MEDLINE, and relevant article bibliographies. RESULTS For MIS articles, we filtered 1480 results and identified 26 studies. For CAN, we searched 464 articles to identify 18 articles for review. For RA, we searched 321 results to identify 7 studies for review. For LITT, we identified 21 articles for review. CONCLUSIONS MIS for the treatment of spine metastasis has significant potential benefits in reducing surgical site infections, hospital stay, and blood loss without compromising instrument accuracy or overall outcomes. Overall, MIS and its adjuncts have the potential to reduce the risks involved in the treatment of patients with metastatic disease to the spinal column without compromising the benefits of decompression and stabilization of the spine.
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Affiliation(s)
- Scott C Flynn
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ilyas M Eli
- Department of Neurosurgery, Lahey Clinic Medical Center, Burlington, Massachusetts, USA; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Zoher Ghogawala
- Department of Neurosurgery, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
| | - Andrew Y Yew
- Department of Neurosurgery, Lahey Clinic Medical Center, Burlington, Massachusetts, USA.
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Kimchi G, Orlev A, Hadanny A, Knoller N, Harel R. Minimally Invasive Spine Surgery: The Learning Curve of a Single Surgeon. Global Spine J 2020; 10:1022-1026. [PMID: 32875823 PMCID: PMC7645089 DOI: 10.1177/2192568219880872] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The learning curve associated with the implementation of minimally invasive spinal surgery (MIS) has been the center of attention in numerous publications. So far, these studies referred to a single MIS procedure. In our view, minimally invasive surgical skills are acquired simultaneously through a variety of procedures that share common features. The aim of this study was to analyze the skills progression of a single surgeon implementing diverse minimally invasive techniques. METHODS We retrospectively collected all patients who underwent spinal surgery for thoracic or lumbar pathology by a single surgeon between 2012 and 2015 at a single institute. Both minimally invasive as well as open surgical techniques were analyzed; these groups were compared on the basis of surgical indications and outcomes. Skills progression analysis in reference to minimally invasive technique was performed. RESULTS A total of 230 patients met the inclusion criteria for this study. MIS group included higher percentage of lumbar discectomy and the open-surgery group included higher percentage of tumor resection surgery. Learning curve evaluation demonstrated increased surgical complexity, evaluated by number of levels treated, over the 4-year period, which corresponded with decreased complication rates. DISCUSSION A gradual increase in surgical complexity over 4 years, together with careful patient selection, enables the surgeon to maintain the rate of complication within acceptable limits. The main challenge facing the MIS community is constructing an education program for MIS surgeons in order to reduce the learning curve-induced complications. CONCLUSION Advancement of educational aids for MIS surgical skill improvement, including spine models, virtual and augmented reality aids and surgical simulators may reduce the learning curve of spine surgeons.
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Affiliation(s)
- Gil Kimchi
- Sheba Medical Center, Ramat-Gan, Affiliated to Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Orlev
- Rabin Medical Center, Petach Tikva, affiliated to Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Nachshon Knoller
- Sheba Medical Center, Ramat-Gan, Affiliated to Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Ran Harel
- Sheba Medical Center, Ramat-Gan, Affiliated to Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel,Ran Harel, Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, 52621, Israel.
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6
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Pennington Z, Ehresman J, Westbroek EM, Lubelski D, Cottrill E, Sciubba DM. Interventions to minimize blood loss and transfusion risk in spine surgery: A narrative review. Clin Neurol Neurosurg 2020; 196:106004. [DOI: 10.1016/j.clineuro.2020.106004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 12/26/2022]
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Kolcun JPG, Ghobrial GM, Crandall KM, Chang KHK, Pacchiorotti G, Wang MY. Minimally Invasive Lumbar Interbody Fusion With an Expandable Meshed Allograft Containment Device: Analysis of Subsidence With 12-Month Minimum Follow-Up. Int J Spine Surg 2019; 13:321-328. [PMID: 31531282 PMCID: PMC6724751 DOI: 10.14444/6044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background We have previously reported the use of a minimally invasive allograft-filled expandable meshed-bag containment system in the lumbar spine. Subsidence has not been reported with this device. In this retrospective case series, we describe subsidence after lumbar interbody fusion using this device, with 12-month minimum radiographic follow-up. Methods Consecutive adult patients that underwent 1- or 2-level interbody fusion with at least 1 year of follow-up were included in this study. Preoperative, postoperative, and final follow-up lumbar radiographs were analyzed to measure disc height at the anterior and posterior margins of the disc space, as well as the neuroforaminal height. Results Forty-one patients were identified, with a mean age of 63.4 years (± 11.8). A total of 61 levels were treated, with successful fusion observed in 54 levels (88.5%). The mean radiographic follow-up was 24.3 months (± 11.2). The mean disc height pre- and postoperatively was 6.9 mm (± 3.2) and 10.1 mm (± 2.9, P < .001), respectively. The mean disc height at final follow-up was 8.3 mm (± 2.4). Average disc height subsidence was 1.8 mm (± 1.7, P < .001). Overall, average disc height increased by a net 1.3 mm (± 2.5, P < .001). The mean neuroforaminal height pre- and postoperatively was 18.0 mm (± 3.3) and 20.7 mm (± 3.6, P < .001), respectively. The mean neuroforaminal height at final follow-up was 19.2 mm (± 3.4). Average neuroforaminal height subsidence was 1.3 mm (± 3.4, P = .012). Overall, average neuroforaminal height increased by a net 1.7 mm (± 2.8, P = .004). No significant difference in subsidence was observed between 1- and 2-level surgeries. Conclusion An expandable allograft containment system is a feasible alternative for lumbar interbody fusion. Due to its biologic and mechanical nature, the surgeon using such constructs should account for an anticipated average of 18% loss of interbody height due to subsidence during the bony remodeling/fusion process.
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Affiliation(s)
- John Paul G Kolcun
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - George M Ghobrial
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Kenneth M Crandall
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ken Hsuan-Kan Chang
- Department of Neurological Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | | | - Michael Y Wang
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Abstract
Due to a worldwide increase of cancer incidence and a longer life expectancy of patients with metastatic cancer, a rise in the incidence of symptomatic vertebral metastases has been observed. Metastatic spinal disease is one of the most dreaded complications of cancer as it is not only associated with severe pain, but also with paralysis, sensory loss, sexual dysfunction, urinary and fecal incontinency when the neurologic elements are compressed. Rapid diagnosis and treatment have been shown to improve both the quality and length of remaining life. This chapter on vertebral metastases with epidural disease and intramedullary spinal metastases will be discussed in terms of epidemiology, pathophysiology, demographics, clinical presentation, diagnosis, and management. With respect to treatment options, our review will summarize the evolution of conventional palliative radiation to modern stereotactic body radiotherapy for spinal metastases and the surgical evolution from traditional open procedures to minimally invasive spine surgery. Lastly, we will review the most common clinical prediction and decision rules, framework and algorithms, and guidelines that have been developed to guide treatment decision making.
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Ghobrial GM, Wang MY, Green BA, Levene HB, Manzano G, Vanni S, Starke RM, Jimsheleishvili G, Crandall KM, Dididze M, Levi AD. Preoperative skin antisepsis with chlorhexidine gluconate versus povidone-iodine: a prospective analysis of 6959 consecutive spinal surgery patients. J Neurosurg Spine 2017; 28:209-214. [PMID: 29171793 DOI: 10.3171/2017.5.spine17158] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to determine the efficacy of 2 common preoperative surgical skin antiseptic agents, ChloraPrep and Betadine, in the reduction of postoperative surgical site infection (SSI) in spinal surgery procedures. METHODS Two preoperative surgical skin antiseptic agents-ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol) and Betadine (7.5% povidone-iodine solution)-were prospectively compared across 2 consecutive time periods for all consecutive adult neurosurgical spine patients. The primary end point was the incidence of SSI. RESULTS A total of 6959 consecutive spinal surgery patients were identified from July 1, 2011, through August 31, 2015, with 4495 (64.6%) and 2464 (35.4%) patients treated at facilities 1 and 2, respectively. Sixty-nine (0.992%) SSIs were observed. There was no significant difference in the incidence of infection between patients prepared with Betadine (33 [1.036%] of 3185) and those prepared with ChloraPrep (36 [0.954%] of 3774; p = 0.728). Neither was there a significant difference in the incidence of infection in the patients treated at facility 1 (52 [1.157%] of 4495) versus facility 2 (17 [0.690%] of 2464; p = 0.06). Among the patients with SSI, the most common indication was degenerative disease (48 [69.6%] of 69). Fifty-one (74%) patients with SSI had undergone instrumented fusions in the index operation, and 38 (55%) patients with SSI had undergone revision surgeries. The incidence of SSI for minimally invasive and open surgery was 0.226% (2 of 885 cases) and 1.103% (67 of 6074 cases), respectively. CONCLUSIONS The choice of either ChloraPrep or Betadine for preoperative skin antisepsis in spinal surgery had no significant impact on the incidence of postoperative SSI.
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Formo M, Halvorsen CM, Dahlberg D, Brommeland T, Fredø H, Hald J, Scheie D, Langmoen IA, Lied B, Helseth E. Minimally Invasive Microsurgical Resection of Primary, Intradural Spinal Tumors is Feasible and Safe: A Consecutive Series of 83 Patients. Neurosurgery 2017; 82:365-371. [DOI: 10.1093/neuros/nyx253] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/07/2017] [Indexed: 12/18/2022] Open
Abstract
Abstract
BACKGROUND
To date, the traditional approach to intraspinal tumors has been open laminectomy or laminoplasty followed by microsurgical tumor resection. Recently, however, minimally invasive approaches have been attempted by some.
OBJECTIVE
To investigate the feasibility and safety of minimally invasive surgery (MIS) for primary intradural spinal tumors.
METHODS
Medical charts of 83 consecutive patients treated with MIS for intradural spinal tumors were reviewed. Patients were followed up during the study year, 2015, by either routine history/physical examination or by telephone consultation, with a focus on tumor status and surgery-related complications.
RESULTS
Mean age at surgery was 53.7 yr and 52% were female. There were 49 schwannomas, 18 meningeomas, 10 ependymomas, 2 hemangioblastomas, 1 neurofibroma, 1 paraganglioma, 1 epidermoid cyst, and 1 hemangiopericytoma. The surgical mortality was 0%. In 87% of cases, gross total resection was achieved. The complication rate was 11%, including 2 cerebrospinal fluid leakages, 1 asymptomatic pseudomeningocele, 2 superficial surgical site infections, 1 sinus vein thrombosis, and 4 cases of neurological deterioration. There were no postoperative hematomas, and no cases of deep vein thrombosis or pulmonary embolism. Ninety-three percent of patients were ambulatory and able to work at the time of follow-up.
CONCLUSION
This study both demonstrates that it is feasible and safe to remove select, primary intradural spinal tumors using MIS, and augments the previous literature in favor of MIS for these tumors.
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Affiliation(s)
- Maja Formo
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Charlotte Marie Halvorsen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Daniel Dahlberg
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Tor Brommeland
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Hege Fredø
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - John Hald
- Department of Neuro-radiology, Oslo University Hospital, Oslo, Norway
| | - David Scheie
- Department of Neuro-pathology, Oslo University Hospital, Oslo, Norway
- Department of Neuropatho-logy, Rigshospitalet, Copenhagen, Denmark
| | - Iver A Langmoen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Bjarne Lied
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
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Pereira EA, Farwana M, Lam KS. Extreme lateral interbody fusion relieves symptoms of spinal stenosis and low-grade spondylolisthesis by indirect decompression in complex patients. J Clin Neurosci 2017; 35:56-61. [DOI: 10.1016/j.jocn.2016.09.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 08/21/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
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Ghobrial GM, Theofanis T, Darden BV, Arnold P, Fehlings MG, Harrop JS. Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature. Neurosurg Focus 2015; 39:E8. [DOI: 10.3171/2015.7.focus15266] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Unintended durotomy is a common occurrence during lumbar spinal surgery, particularly in surgery for degenerative spinal conditions, with the reported incidence rate ranging from 0.3% to 35%. The authors performed a systematic literature review on unintended lumbar spine durotomy, specifically aiming to identify the incidence of durotomy during spinal surgery for lumbar degenerative conditions. In addition, the authors analyzed the incidence of durotomy when minimally invasive surgical approaches were used as compared with that following a traditional midline open approach.
METHODS
A MEDLINE search using the term “lumbar durotomy” (under the 2015 medical subject heading [MeSH] “cerebrospinal fluid leak”) was conducted on May 13, 2015, for English-language medical literature published in the period from January 1, 2005, to May 13, 2015. The resulting papers were categorized into 3 groups: 1) those that evaluated unintended durotomy rates during open-approach lumbar spinal surgery, 2) those that evaluated unintended durotomy rates during minimally invasive spine surgery (MISS), and 3) those that evaluated durotomy rates in comparable cohorts undergoing MISS versus open-approach lumbar procedures for similar lumbar pathology.
RESULTS
The MEDLINE search yielded 116 results. A review of titles produced 22 potentially relevant studies that described open surgical procedures. After a thorough review of individual papers, 19 studies (comprising 15,965 patients) pertaining to durotomy rates during open-approach lumbar surgery were included for analysis. Using the Oxford Centre for Evidence-Based Medicine (CEBM) ranking criteria, there were 7 Level 3 prospective studies and 12 Level 4 retrospective studies. In addition, the authors also included 6 studies (with a total of 1334 patients) that detailed rates of durotomy during minimally invasive surgery for lumbar degenerative disease. In the MISS analysis, there were 2 prospective and 4 retrospective studies. Finally, the authors included 5 studies (with a total of 1364 patients) that directly compared durotomy rates during open-approach versus minimally invasive procedures. Studies of open-approach surgery for lumbar degenerative disease reported a total of 1031 durotomies across all procedures, for an overall durotomy rate of 8.11% (range 2%–20%). Prospectively designed studies reported a higher rate of durotomy than retrospective studies (9.57% vs 4.32%, p = 0.05). Selected MISS studies reported a total of 93 durotomies for a combined durotomy rate of 6.78%. In studies of matched cohorts comparing open-approach surgery with MISS, the durotomy rates were 7.20% (34 durotomies) and 7.02% (68), respectively, which were not significantly different.
CONCLUSIONS
Spinal surgery for lumbar degenerative disease carries a significant rate of unintended durotomy, regardless of the surgical approach selected by the surgeon. Interpretation of unintended durotomy rates for lumbar surgery is limited by a lack of prospective and cohort-matched controlled studies.
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Affiliation(s)
- George M. Ghobrial
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital., Philadelphia, Pennsylvania
| | - Thana Theofanis
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital., Philadelphia, Pennsylvania
| | | | - Paul Arnold
- 3Department of Neurosurgery, University of Kansas, Kansas City, Kansas; and
| | | | - James S. Harrop
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital., Philadelphia, Pennsylvania
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Sclafani JA, Raiszadeh K, Raiszadeh R, Kim P, Doerr T, Siddiqi F, LaMotta I, Park P, Templin C, Gill S, Liang K, Kim CW. Validation and analysis of a multi-site MIS Prospective Registry through sub-analysis of an MIS TLIF Subgroup. Int J Spine Surg 2014; 8:14444-1004. [PMID: 25694921 PMCID: PMC4325489 DOI: 10.14444/1004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
STUDY DESIGN Retrospective analysis of multi-site, prospectively collected database. OBJECTIVE To assess the validity and utility of a prospective spine registry by sub-analysis of patients treated with MIS TLIF. BACKGROUND The MIS registry is a large-scale, multi-center series of prospectively collected clinical information on outcomes, complications, and adverse events for minimally invasive spine procedures for the treatment of degenerative lumbar conditions. METHODS Analysis was performed on the MIS Prospective Registry database. A subgroup of patients treated by MIS TLIF technique was identified. Statistical analyses were performed on pre and post-operative data collected using validated health related quality of life outcome tools. Missing 1-year patient follow-up data was obtained through progressive correspondence modalities. RESULTS Data analysis was performed on 98 MIS TLIF patients (56 female, 42 male) with a median age of 64.5 years (range 25-91 years) which were extracted from a total registry population of 478 patients. The one year follow-up rate was 87%. A total of 64 single-level, 23 two-level, 3 three-level, and 3 combined TLIFs staged with an MIS lateral procedure were included. The primary surgical indications were spondylolisthesis (27%), central stenosis (25%), foraminal stenosis (14%), post-laminectomy syndrome (14%) and degenerative scoliosis (6%). The peri-operative blood transfusion rate was 3%. Complications included intraoperative dural tear (n = 3), deep wound infection (n = 2), superficial dehiscence/cellulitis (n = 2). There was a 4% re-operation rate at the 1 year post-operative time point. Half of patients were discharged within 2 days (range 1-11 days, mean 2.97 days, median 2 days). All patients that were discharged on the first post-operative day (n = 14) underwent a single-level MIS TLIF procedure and had significantly lower pre-op disability index score than those discharged on POD 3-5 (43.7 ± 15.5 vs. 56.0 ± 18.3, p = 0.04). Average ODI scores in the subgroup of patients that had reached the one year postoperative time point were 46.5 pre-op (n = 46), and 26.2 at 1 year post-op (n = 40, p = 0.0001). There was significant improvement in VAS scores: pre-operative (back = 6.7, leg = 5.4, n = 46), and 1 year post-operative (back = 3.2, leg = 1.7, n = 40, p = 0.0001). Patients with pre-operative ODI scores greater than 50 demonstrated significant improvement starting at the 6 week post-operative time point (24 point improvement, n = 46, p < 0.001). A pre-operative ODI between 35-50 showed significant improvement starting at 3 months (15.5 point improvement, n = 29, p = 0.05). Patients with a pre-operative ODI score less than 35 had an initial period of increased disability with a trend towards significant improvement by 3 months post-op (n = 20). CONCLUSIONS Initial findings of the MIS Prospective Registry show patients can be enrolled in a relatively short time period and patient based questionnaires can successfully be obtained through a combination of clinic follow-up appointments and remote correspondence. Outcomes of the MIS Registry MIS TLIF subgroup were consistent with previously published MIS TLIF studies. Sub-analysis of data collected through level-specific patient diagnosis and treatment modalities permits outcome analysis of a wide breadth of spinal conditions and interventions.
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Affiliation(s)
- Joseph A. Sclafani
- Spine Institute of San Diego, Minimally Invasive Spine Center of Excellence
| | - Kamshad Raiszadeh
- Spine Institute of San Diego, Minimally Invasive Spine Center of Excellence
| | - Ramin Raiszadeh
- Spine Institute of San Diego, Minimally Invasive Spine Center of Excellence
| | - Paul Kim
- Spine Institute of San Diego, Minimally Invasive Spine Center of Excellence
| | | | | | | | | | | | | | | | - Choll W. Kim
- Spine Institute of San Diego, Minimally Invasive Spine Center of Excellence
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Lorio MP, Polly DW, Ninkovic I, Ledonio CGT, Hallas K, Andersson G. Utilization of Minimally Invasive Surgical Approach for Sacroiliac Joint Fusion in Surgeon Population of ISASS and SMISS Membership. Open Orthop J 2014; 8:1-6. [PMID: 24551025 PMCID: PMC3924210 DOI: 10.2174/1874325001408010001] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 11/22/2022] Open
Abstract
Introduction: The sacroiliac joint (SIJ) may be a source of chronic low back pain in 15 -22% of patients. Over
the past four years MIS is an emerging standard of care for SI joint fusion. The International Society for the Advancement
of Spine Surgery (ISASS) and Society for Minimally Invasive Spine Surgery (SMISS) conducted a survey of their
members to examine current preferences in surgeon practice of MIS SI fusion. Methods: To qualify for survey participation, the surgeon had to perform at least one open or MIS SIJ fusion procedure
between 2009 and 2012. All surgeons were instructed to review their records. This included the number of surgical
procedures performed annually from 2009-2012, site of service where each procedure was commonly performed, and
average length of stay for each approach. Results: Twenty four percent (121/500) of the eligible members participated in this survey. This survey revealed that the
percentage of MIS procedures increased from 39% in 2009 to over 87% in 2012. The survey showed a significant increase
in average number of MIS surgeries and a significant difference between open and MIS surgeries in 2012 (p<0.0001). In
addition, 80% of the survey respondents indicated a lack of preference toward open approach if that was the only
available option. Conclusions: According to performed survey, MIS SIJ fusion is preferred over open technique. Incorporation of the MIS
technique into the spine surgeon's specter of skills would allow an increased number of surgical options as well as
possible increase in outcome quality.
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Affiliation(s)
| | - David W Polly
- Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Ivana Ninkovic
- Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Gunnar Andersson
- Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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15
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McAfee PC, Shucosky E, Chotikul L, Salari B, Chen L, Jerrems D. Multilevel extreme lateral interbody fusion (XLIF) and osteotomies for 3-dimensional severe deformity: 25 consecutive cases. Int J Spine Surg 2013; 7:e8-e19. [PMID: 25694908 PMCID: PMC4300965 DOI: 10.1016/j.ijsp.2012.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background This is a retrospective review of 25 patients with severe lumbar nerve root compression undergoing multilevel anterior retroperitoneal lumbar interbody fusion and posterior instrumentation for deformity. The objective is to analyze the outcomes and clinical results from anterior interbody fusions performed through a lateral approach and compare these with traditional surgical procedures. Methods A consecutive series of 25 patients (78 extreme lateral interbody fusion [XLIF] levels) was identified to illustrate the primary advantages of XLIF in correcting the most extreme of the 3-dimensional deformities that fulfilled the following criteria: (1) a minimum of 40° of scoliosis; (2) 2 or more levels of translation, anterior spondylolisthesis, and lateral subluxation (subluxation in 2 planes), causing symptomatic neurogenic claudication and severe spinal stenosis; and (3) lumbar hypokyphosis or flat-back syndrome. In addition, the majority had trunks that were out of balance (central sacral vertical line ≥2 cm from vertical plumb line) or had sagittal imbalance, defined by a distance between the sagittal vertical line and S1 of greater than 3 cm. There were 25 patients who had severe enough deformities fulfilling these criteria that required supplementation of the lateral XLIF with posterior osteotomies and pedicle screw instrumentation. Results In our database, with a mean follow-up of 24 months, 85% of patients showed evidence of solid arthrodesis and no subsidence on computed tomography and flexion/extension radiographs. The complication rate remained low, with a perioperative rate of 2.4% and postoperative rate of 12.2%. The lateral listhesis and anterior spondylolisthetic subluxation were anatomically reduced with minimally invasive XLIF. The main finding in these 25 cases was our isolation of the major indication for supplemental posterior surgery: truncal decompensation in patients who are out of balance by 2 cm or more, in whom posterior spinal osteotomies and segmental pedicle screw instrumentation were required at follow up. No patients were out of sagittal balance (sagittal vertical line <3 cm from S1) postoperatively. Segmental instrumentation with osteotomies was also more effective for restoration of physiologic lumbar lordosis compared with anterior stand-alone procedures. Conclusions This retrospective study supports the finding that clinical outcomes (coronal/sagittal alignment) improve postoperatively after minimally invasive surgery with multilevel XLIF procedures and are improved compared with larger extensile thoracoabdominal anterior scoliosis procedures.
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Affiliation(s)
- Paul C McAfee
- Spine and Scoliosis Center, University of Maryland, St. Joseph Medical Center, Towson, MD
| | - Erin Shucosky
- Spine and Scoliosis Center, University of Maryland, St. Joseph Medical Center, Towson, MD
| | - Liana Chotikul
- Spine and Scoliosis Center, University of Maryland, St. Joseph Medical Center, Towson, MD
| | - Ben Salari
- Spine and Scoliosis Center, University of Maryland, St. Joseph Medical Center, Towson, MD
| | - Lun Chen
- Spine and Scoliosis Center, University of Maryland, St. Joseph Medical Center, Towson, MD
| | - Dan Jerrems
- Spine and Scoliosis Center, University of Maryland, St. Joseph Medical Center, Towson, MD
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