scholarly journals Minimally Invasive Posterior Cervical Discectomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Seokchun Lim ◽  
Thomas Marcus Zervos ◽  
Travis Hamilton ◽  
Victor Chang
Keyword(s):  
Minimally Invasive ◽  
Healthcare Cost ◽  
Cost Savings ◽  
Herniated Disc ◽  
Ambulatory Setting ◽  
Invasive Technique ◽  
Foraminal Stenosis ◽  
Illustrative Case ◽  
Cervical Discectomy ◽  
Splitting Technique

Abstract Minimally invasive posterior cervical microdiscectomy is an appropriate surgical approach for patients with foraminal stenosis from herniated disc with radicular symptoms that is not responsive to conservative management. While anterior cervical discectomy and fusion (ACDF) or arthroplasty is increasingly utilized to treat herniated disc, a posterior approach eliminates the risk of potential approach related injuries to the esophagus, carotid artery, or recurrent laryngeal nerve. Additional benefits of posterior decompression include avoidance of instrumentation, which represents an increased healthcare cost, as well as potential long-term risks of adjacent-level pathologies or device failures.  A traditional open posterior cervical approach has the potential to cause significant postoperative pain due to dissection of the paraspinal musculature and the potential for disrupting the posterior tension band with inadvertent injury to the interspinous ligaments. Such disadvantages are reduced by utilizing the minimally invasive technique where a small tubular working channel is placed through a muscle splitting technique via a paramedian approach. This technique minimizes the need for muscle stripping, and thus decreases postoperative functional and structural disturbance. Discectomy in this case can also be safely performed with minimal retraction at the axilla of the nerve root. Additionally, this approach can be utilized in an ambulatory setting, which coupled with the lack of any additional instrumentation helps contribute to the overall healthcare cost savings of such a procedure.  This video describes how the minimally invasive posterior cervical discectomy can be effectively and safely performed in this illustrative case. The patient consented to the procedure and publication.

scholarly journals Robot-assisted revision of sacroiliac joint fusion using a triangular titanium implant in an S2-alar-iliac trajectory: illustrative case

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Matthew Triano ◽  
Islam Fayed ◽  
Faheem A. Sandhu
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Sacroiliac Joint ◽  
Titanium Implant ◽  
Invasive Technique ◽  
Illustrative Case ◽  
Robot Assisted ◽  
Invasive Approach

BACKGROUND Sacroiliac joint (SIJ) dysfunction can lead to significant pain and disability, greatly impairing quality of life. Arthrodesis may take up to 1 year to occur, after which revision can be considered. There is a need for highly accurate and reproducible techniques for revision that allow for purchase through undisturbed bone to prevent prolonged pain and disability. Moreover, a minimally invasive technique for revision would be favorable for recovery, particularly in elderly patients. OBSERVATIONS An 84-year-old man with a prior history of lumbar fusion presented with severe buttock pain limiting ambulation and sitting because of the failure of arthrodesis after SIJ fusion 1 year earlier. He underwent revision using a triangular titanium implant (TTI) in an S2-alar-iliac (S2-AI) trajectory under robotic guidance, which is a novel technique not yet described in the literature. The patient’s pain largely resolved, he was able to ambulate independently, and his quality of life improved tremendously. There were no complications of surgery. LESSONS Placement of a TTI using an S2-AI trajectory is a safe and effective method for revision that can be considered for elderly patients. Robot-assisted navigation can be used to facilitate an accurate and reproducible approach using a minimally invasive approach.

scholarly journals Transforaminal Endoscopic Treatment of Lumbar Radiculopathy after Instrumented Lumbar Spine Fusion

2015 ◽  
Vol 2;18 (2;3) ◽  
pp. 179-184
Author(s):  
Albert E. Telfeian
Keyword(s):  
Retrospective Study ◽  
Minimally Invasive ◽  
Lumbar Fusion ◽  
Herniated Disc ◽  
Invasive Technique ◽  
Lumbar Radiculopathy ◽  
Vas Score ◽  
Constant Pain ◽  
Endoscopic Discectomy ◽  
One Year

Background: Transforaminal endoscopic discectomy and foraminotomy is a well-described minimally invasive technique for surgically treating lumbar radiculopathy caused by a herniated disc and foraminal narrowing. Objective: To describe the technique and feasibility of transforaminal foraminoplasty for the treatment of lumbar radiculopathy in patients who have already undergone instrumented spinal fusion. Study Design: Retrospective study. Setting: Hospital and ambulatory surgery center Methods: After Institutional Review Board approval, charts from 18 consecutive patients with lumbar radiculopathy and instrumented spinal fusions who underwent endoscopic procedures between 2008 and 2013 were reviewed. Results: The average pain relief one year postoperatively was reported to be 67.0%, good results as defined by MacNab. The average preoperative VAS score was 9.14, indicated in our questionnaire as severe and constant pain. The average one year postoperative VAS score was 3.00, indicated in our questionnaire as mild and intermittent pain. Limitations: This is a retrospective study and only offers one year follow-up data for patients with instrumented fusions who have undergone endoscopic spine surgery. Conclusion: Transforaminal endoscopic discectomy and foraminotomy could be used as a safe, yet, minimally invasive and innovative technique for the treatment of lumbar radiculopathy in the setting of previous instrumented lumbar fusion. IRB approval: Meridian Health: IRB Study # 201206071J Key words: Endoscopic siscectomy, minimally-invasive, transforaminal, fusion

scholarly journals Instrumented Outpatient Anterior Cervical Discectomy and Fusion: Is it Safe?

2012 ◽  
Vol 97 (1) ◽  
pp. 86-89 ◽  
Author(s):  
Courtney S Sheperd ◽  
William F Young
Keyword(s):  
Outpatient Surgery ◽  
Cost Savings ◽  
Anterior Cervical Discectomy ◽  
Ambulatory Setting ◽  
Outpatient Basis ◽  
Potential Cost ◽  
Cervical Discectomy ◽  
Hospital Emergency Room ◽  
Cervical Swelling ◽  
High Degree

Abstract Anterior cervical discectomy and fusion procedures are one of the most common procedures performed in spinal surgery. Increasingly they are being performed on an outpatient basis. The primary impetus for performing procedures as an outpatient is potential cost savings. However, there are few studies discussing the safety of performing the procedure in an ambulatory setting. This is a retrospective review of our initial experience in performing anterior cervical discectomy and fusion procedures with instrumentation (ACDFI) in an ambulatory surgery center dedicated to spine surgery. Patients were selected for outpatient surgery if they had limited co-morbidities and the surgery involved only 1 or 2 levels. One hundred fifty-two patients underwent outpatient ACDFI during the study period (2007–2009). Six patients returned to the hospital emergency room after discharge. The reasons for evaluation included 2 for neck pain, 1 for dysphagia, 1 for vocal cord paralysis and dysphagia, 1 for nausea, and 1 for cervical swelling. Only 1 of the 6 patients required admission to the hospital. None of the 6 suffered any long-term sequelae. The overall complication rate was 3.9%. A self-reported survey was completed by 75 patients within 6 months of surgery, and there was a 100% satisfaction rate among responders. ACDFI can be performed safely on an outpatient in selected patients with a high degree of patient satisfaction. Our experience is consistent with those of previous investigators.

A minimally invasive technique for L5–S1 intraforaminal disc herniations: microdiscectomy with a tubular retractor via a contralateral approach

2008 ◽  
Vol 8 (2) ◽  
pp. 193-198 ◽  
Author(s):  
Jin S. Yeom ◽  
Kyeong Hwan Kim ◽  
Soon Woo Hong ◽  
Kun-Woo Park ◽  
Bong-Soon Chang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Contralateral Side ◽  
Minimally Invasive Technique ◽  
Herniated Disc ◽  
Invasive Technique ◽  
Neural Foramen ◽  
Tubular Retractor ◽  
Stabilization Procedure ◽  
Disc Herniations ◽  
Operative Microscope

✓ Surgical treatment of intraforaminal disc herniations at the L5–S1 level is technically demanding. The 2 most commonly used procedures involve either a medial or lateral ipsilateral approach and often require a partial or even complete facet resection, which may in turn result in vertebral instability and/or back pain, as well as, in some cases, a fusion or stabilization procedure. In this report, the authors present a new minimally invasive technique for the treatment of L5–S1 intraforaminal disc herniations. Using this technique, which involves tubular retractors and an operative microscope to approach the neural foramen from the contralateral side, the authors could easily visualize and remove the herniated disc material and perform a thorough microdiscectomy with minimal resection of osseous and ligamentous structures. To illustrate this new minimally invasive technique for the treatment of intraforaminal disc herniations at L5–S1, they describe the cases of 2 patients who underwent the procedure and in whom successful results were achieved.

scholarly journals TREATMENT OF LUMBAR HERNIAS BY ENDOSCOPIC NUCLEOPLASTY WITH RADIOFREQUENCY

2016 ◽  
Vol 15 (1) ◽  
pp. 36-39 ◽  
Author(s):  
Heber Humberto Alfaro Pachicano ◽  
Alejandro Ramos Trujillo
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Oswestry Disability Index ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Invasive Technique ◽  
Outpatient Basis ◽  
Minimal Rate ◽  
Clinical Records

ABSTRACT Objective: To evaluate the postoperative outcomes of minimally invasive technique for treating lumbar disc herniation in patients undergoing percutaneous endoscopic nucleoplasty with radiofrequency in the center of minimally invasive procedures Veracruz (CEMIVER) of the HRAEV.. Methods: A descriptive, comparative, ambispective and longitudinal study. The clinical records of patients who underwent herniated disc surgery were reviewed from March 2010 to March 2015. Inclusion criteria were individuals of both sexes, aged 18-65 years, with disc herniation diagnosis by MRI, evocative discography (pain) and clinical evaluation. The variables were analyzed by VAS, Oswestry disability index for functional assessment and Macnab criteria for modified retrospective cross clinical classification. Results: 161 patients were included, 81 female and 80 male, aged between 18 and 65 years with severe (83.8%) and moderate (16.2%) disability according to the Oswestry disability index; the total of excellent results was 83.8%, 9.5% were good, 4.8% were median and 1.9% were poor results, according to the Macnab criteria; the average time of surgery was 84 minutes per procedure, and the postoperative average bleeding was 65 ml. Of the total, 87.4% of the patients were on an outpatient basis and 7.6% had a short hospital stay.. Conclusion: It was found that percutaneous endoscopic nucleoplasty with radiofrequency technique is a procedure that offers great benefits for patients with lumbar disc herniation, including performing it under local anesthesia, with clear visualization of the surgical field, minimal pain, little bleeding, shorter operative time, does not cause instability of anatomical structures and has minimal rate of complications.

scholarly journals Technique of Minimally Invasive Cervical Foraminotomy

2017 ◽  
Vol 13 (6) ◽  
pp. 693-701 ◽  
Author(s):  
Donald A Ross ◽  
Kelly J Bridges
Keyword(s):  
Minimally Invasive ◽  
Specific Treatment ◽  
Large Series ◽  
Invasive Technique ◽  
Foraminal Stenosis ◽  
Posterior Cervical Foraminotomy ◽  
Posterior Foraminotomy ◽  
Invasive Techniques ◽  
Cervical Foraminotomy ◽  
Attention To Detail

Abstract BACKGROUND Posterior cervical foraminotomy is a long utilized and commonly performed procedure, but has been supplanted in many cases by anterior procedures. With the advent of minimally invasive techniques, posterior foraminotomy may again deserve a prominent place in the treatment of cervical foraminal stenosis. OBJECTIVE To report in detail a successfully utilized minimally invasive technique and the results in a large series of patients, by a single author. METHODS The technique is described and illustrated in detail. A retrospective review of the use of this technique in a large series is reported. RESULTS Precise details of the technique are described with specific attention to complication avoidance. In over 360 cases, there have been no nerve root injuries other than idiopathic C5 palsies, no wound infections, and a single durotomy that required no specific treatment. CONCLUSION Minimally invasive posterior cervical foraminotomy is a well-tolerated and effective procedure which can be performed with minimal complications when attention to detail is maintained.

Lumbar spinous process-splitting technique for ligamentum flavum cyst removal: the first use in Europe.

2021 ◽  
Author(s):  
Santino Ottavio Tomasi ◽  
Giuseppe Emmanuele Emmanuele Umana ◽  
Gianluca Scalia ◽  
Giuseppe Raudino ◽  
Vlado Stevanovic ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Ligamentum Flavum ◽  
Spinous Process ◽  
Case Series ◽  
Invasive Technique ◽  
Paraspinal Muscles ◽  
Splitting Technique ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
Lumbar Spinous Process

Background Laminotomy for lumbar stenosis is a well-defined procedure and represents a routine in every neurosurgical department. It is a common experience that the mono- or bilateral paraspinal muscles detachment together with supra and interspinous ligaments injury can lead to postoperative pain. In literature has been reported the application at the level of the lumbar spine of a minimally invasive technique defined as lumbar spinous process-splitting technique (LSPST). Methods In the current study, we present a case series of 12 patients that underwent LSPSL from September 2019 to April 2020. Two patient suffering from ligamentum flavum cyst, 8 patients with single level lumbar canal stenosis (LCS) and two patients with two-level LCS. The approach was mini-open, with reduced soft tissue dissection and without paraspinal muscles injury. Moreover, a novel morphological classification of postoperative muscle atrophy is proposed as well as a volumetric analysis of the decompression achieved. Conclusion At our knowledge, this is the first description of this surgical technique and the first LSPSL case series in Europe. Furthermore, cases of ligamentum flavum cyst removal using this safe and effective technique are not yet reported. Abbreviations Lumbar canal stenosis (LCS), lumbar spinous process-splitting technique (LSPST), minimally invasive spine surgery (MISS)

scholarly journals Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mohamed I. Refaat ◽  
Amr K. Elsamman ◽  
Adham Rabea ◽  
Mohamed I. A. Hewaidy
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Technique ◽  
Decompression Surgery ◽  
Microsurgical Decompression ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

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