Minimal access surgical techniques have been described for diskectomy and laminectomy procedures performed through tubular exposures. Tubular exposures, however, restrain visibility to a fixed diameter and require co-axial instrument manipulation. An independent blade retractor system has been developed to overcome the obstacles of working through a tube. Decompression and circumferential fusion can be accomplished through this minimal access exposure via a combination of laminectomy and transforaminal lumbar interbody fusion (TLIF) coupled with minimally invasive pedicle screw fixation. Herein, we describe a minimally-invasive technique for TLIF exposure. Illustrations, intraoperative photographs, and fluoroscopic images supplement this technique. We found that the described minimally-invasive system provides comparable exposure to the traditional-open techniques with the benefits of minimally-invasive techniques. Additionally, it does not have the added constraints of a tubular system. We were able to perform TLIFs without any additional complications. Minimal access decompression and TLIF can be performed safely and effectively using this minimally-invasive system. Besides the retractor system, no additional specialized instruments are required. An operative microscope is not required, in fact, all our cases were performed using operative loupes. The light attachment provides superb visbility without the discomfort of having to wear a headlight. Thus far we have found no added risks or complications using this system. We are currently working on long-term analysis and follow-up to further evaluate this system's efficacy.

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Purpose: Acute kidney injury (AKI) is a frequent complication of cardiac transplantation and associated with adverse outcomes within the first postoperative year. This study describes the association between AKI and long-term adverse outcome after cardiac transplantation. Methods: The study population included 471 adult recipients that survived the first postoperative year. AKI was defined by the Kidney Disease Improving Global Outcome (KDIGO) criteria. Primary outcome variables were overall and renal survival defined as time to start of chronic renal replacement therapy (RRT). The secondary outcome variable was renal function 10 years after transplantation. Results: Overall survival rates were 90%, 64%, 29%, 20% and 11% and renal survival rates were 97%, 84%, 76%, 69% and 69%, at 5,10,15,20 and 25 years, respectively. No crude association was found between AKI staged by KDIGO criteria and mortality (P= 0.50) or chronic RRT dependence (P= 0.47). Additionally, no crude association was found for AKI requiring RRT and mortality (P= 0.27). A significant association was found between AKI requiring RRT and a higher risk for chronic RRT dependence (P= 0.02). In multivariable analysis AKI requiring RRT was associated with an increased risk for mortality (HR= 2.75, P= 0.03) and chronic RRT dependency (HR= 13.14, P< 0.001). In addition, also an estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73m2 at one year after transplantation was associated with mortality (HR= 2.69, P< 0.001) and an eGFR 30-59 (HR= 3.57, P= 0.007) and an eGFR < 30 (HR= 16.53, P< 0.001) with chronic RRT dependence, respectively. Furthermore, independent association was found between AKI requiring RRT and renal function 10 years thereafter (β =-29.72, P= 0.02). Conclusion: Besides AKI requiring RRT, less severe episodes of AKI have limited implications for the cardiac transplantation recipient's long-term prognosis. However, impaired renal function one year after transplantation is an important predictor for long-term mortality and chronic RRT dependence.