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How to perform revision lumbar decompression at the index level through a minimally invasive (MIS) approach
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Aaron Hillis, Christoph Wipplinger, Sertac Kirnaz, Franziska A. Schmidt, Roger Härtl
In our practice, we begin pain management intraoperatively by applying epidural steroids, such as 40 mg of Solu-Medrol (methyl-prednisolone). Furthermore, local anesthetic Marcaine (buvicaine) is administered intramuscularly. In order to achieve immediate postoperative pain control, patients are treated with a combination of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen) and opioids, such as Vicodin. Due to the reduced muscle trauma in minimally invasive spine surgery, the administration of additional opioids is often not required. Nevertheless, care should be taken to administer proton pump inhibitors (PPIs) in the case of prolonged NSAID treatment, and also to discontinue opioid treatment as soon as possible. In our experience, analgesic treatment is generally not required for more than 2–3 weeks postoperatively for minimally invasive redo lumbar surgery.
Endoscopic Techniques for Stabilization of the Thoracic Spine
Published in Alexander R. Vaccaro, Christopher M. Bono, Minimally Invasive Spine Surgery, 2007
Max C. Lee, Bernard A. Coert, Se-Hoon Kim, Daniel H. Kim
The technological advancements made within spinal surgery have increased dramatically within the last two decades. Innovative techniques, from the use of the operating microscope to image guidance, have changed our approach to problems within the operating room. In addition, improved instrumentation (from odontoid screws and lateral mass screws to sacropelvic fixation) has improved the surgical management of countless patients. It is these changes that have collectively led to the advancement of spinal surgery and subsequent improved outcomes. One of the major advancements within the last decade has been the development of minimally invasive spinal surgery. Within this arena, development of thoracoscopic spinal surgery has skyrocketed.
Device profile of the XVision-spine (XVS) augmented-reality surgical navigation system: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2021
Christopher F. Dibble, Camilo A. Molina
The use of AR in spine surgery represents an evolution in our surgical capabilities, both because of the increased precision of screw placement and the advantage of appreciating complex 3D anatomy. Indeed, one way to think of the goal of AR spine technology is to ‘de-skill’ complex tasks such as screw placement. AR has applications in both open and minimally invasive spine surgery. Currently, the field of AR surgical navigation is growing as the technology becomes available at smaller hospitals and surgical centers, already being present in many academic institutions. Barriers to adoption include concern for operator learning curve, workflow/technical changes, and cost. And when modern navigation or navigated robotics is used, the technical problems of LOS interruption and attention shift become apparent.
Endoscopic transforaminal lumbar interbody fusion: a comprehensive review
Published in Expert Review of Medical Devices, 2019
Yong Ahn, Myung Soo Youn, Dong Hwa Heo
As quality of life and longevity have become key aims of health care, there is an increasing and critical need for the development of minimally invasive spine surgery (MISS) techniques. MISS has many advantages including minimal tissue damage, reduced incidence of perioperative complications, early recovery, and higher cost-effectiveness. Among MISS approaches, endoscopic spine surgery has received substantial attention. Having been originally introduced for the treatment of lumbar pain and radiculopathy stemming from lumbar disc herniation [1,2], over the past 45 years, percutaneous endoscopic lumbar discectomy techniques have evolved into effective strategies for the management of a wide range of degenerative disc diseases. In particular, transforaminal percutaneous endoscopic lumbar discectomy and related techniques have been employed for the management of lumbar disc herniation and lumbar stenosis [3–8]. The effectiveness of endoscopic spinal surgery techniques has been proven in several randomized trials [9–12] and meta-analyses [13–17].
Device solutions for a challenging spine surgery: minimally invasive transforaminal lumbar interbody fusion (MIS TLIF)
Published in Expert Review of Medical Devices, 2019
Arash J. Sayari, Dil V. Patel, Joon S. Yoo, Kern Singh
Minimally invasive spine surgery continues to evolve as our understanding of complex spinal pathologies and treatments expands. The introduction of the MIS TLIF has allowed for a paradigm shift in the treatment of lumbar degeneration and instability, while leaving a small surgical footprint. However, challenges still exist, both in mastering the surgical technique and selecting appropriate devices to optimize outcomes. In general, advances in interbody cage technology has allowed optimal fusion rates and stability, even through minimally invasive approaches. Similarly, pedicle screw and rod systems provide immediate structural support until interbody fusion of the spinal segment is complete. Finally, multiple bone graft options have been developed to enhance fusion and have offered osteointegrative properties that are safe and effective supplements to providing maximal fusion rates. This review has detailed several options that allow spine surgeons to make informed decisions regarding surgical devices for their patients scheduled for a MIS TLIF.