History and Evolution of Minimally Invasive Spine Surgery

Hernandez, R. Nick; Nakhla, Jonathan; Navarro-Ramírez, Rodrigo; Härtl, Roger

doi:10.1007/978-3-030-19007-1_1

Cited by 2 publications

(3 citation statements)

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“…In our study, we have described a modification to the typical diskectomy workflow wherein an “over-the-top” decompression is performed upfront to create space for the safe delivery of thefragment. 14,20…”

Section: Discussionmentioning

confidence: 99%

“…12 These complicating features and the frequently urgent fashion in which these patients need treatment have led to a reluctance among spine surgeons to adopt minimally invasive surgery (MIS) approaches for these cases and driven the belief that a central open approach with the possibility of bilateral laminectomy is necessary instead. 7,9,13-15 This is despite the fact that MIS approaches, such as a tubular approach, to the spine have already been shown to be a good alternative to open surgical procedures for a wide variety of technically challenging pathology. 16-19 In this case series, we describe a modification to the typical diskectomy workflow wherein a unilateral laminectomy for bilateral decompression or so-called over-the-top decompression is performed upfront to create space for the safe delivery of the giant fragment.…”

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confidence: 99%

“…22 The unilateral laminectomy for bilateral decompression technique has been described before, but the evidence for its use for the treatment of GDHs is still pending. 14,20,22 Because there are no reports and no evidence in the literature on the safety and efficacy of minimally invasive treatment of GDHs, we also conducted a review of the patients with GDHs who were treated in such a manner at our institution. To our knowledge, this is the first evaluation of the treatment of lumbar GDHs by a tubular MIS approach.…”

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confidence: 99%

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Lumbar Giant Disk Herniations Treated With a Unilateral Approach for Bilateral Decompression

Sommer

McGrath

Kırnaz

et al. 2022

Operative Neurosurgery

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BACKGROUND: Disk herniations that obstruct the spinal canal by more than 50% are named “giant disk herniations” (GDHs). GDHs are challenging to treat from a surgical perspective because of their size and the risk of iatrogenic manipulation during resection resulting in additional neurological compromise. As a result, the appropriateness of minimally invasive tubular approaches for the treatment of lumbar GDHs remains controversial. OBJECTIVE: To report our experience in treating lumbar GDHs using tubular minimally invasive surgery. METHODS: A total number of 228 disk herniations were evaluated for the criteria of GDH. In addition, the presence of neurological deficits such as cauda equina syndrome, pain as measured by a visual analog scale, operating time, complications, estimated intraoperative blood loss, and number of surgical revisions were assessed. The standard tubular diskectomy technique was modified to include unilateral laminectomy for bilateral decompression before the diskectomy to create a sufficient working space for removal of the disk fragments. RESULTS: Twenty-three (10%) patients met the criteria for GDH. Clinically significant motor weakness was present in 21 patients (91.3%) before surgery, and 3 patients (13%) presented with cauda equina syndrome. The average mean visual analog scale (±SD) for the preoperative pain score was 8.3 and decreased to 2.4 at follow-up after surgery. All cases of cauda equina syndrome resolved postoperatively. CONCLUSION: Unilateral tubular minimally invasive surgery diskectomy seems to be a safe and effective treatment alternative for lumbar GDHs, combined with the “over-the-top” decompression, which provides bilateral decompression and working space.

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Section: Discussionmentioning

confidence: 99%