MIS Issue of Techniques in Orthopedics

Abstract

Minimally invasive spine surgery is a combination of both philosophy and practice. Over the past decade, it has become increasing popular in the field of spinal surgery. Practioners of this burgeoning field theorize that the preservation of the soft tissue envelope surrounding the spine during surgery may lower the morbidity of the surgical approach and may ultimately improve short and long-term outcomes after spinal procedures. Today, the evolving demands of our fractionated heath care system in the United States has evoked greater attention toward safer, more efficacious, and cost-effective treatments regarding patient care. Similarly, patients and practioners have higher expectations of clinical outcomes with a correspondingly lower interest in surgical and postoperative morbidity and complications. Negative postoperative sequelae may exist pertaining to the spinal patient in the immediate perioperative/postoperative period, and in the long-term follow-up period. Short-term issues include prolonged operative procedures, extensive blood loss, and postoperative pain, which may all lead to extended hospital stays. Longer term sequelae include chronic pain that has been attributed to postlaminectomy syndrome, adjacent segment degeneration, and “failed back” syndrome. These issues continue to confound practitioners, and have negative consequences for patient outcomes. Thus, with the potential to diminish the sequelae of more traditional surgical approaches, less invasive approaches and techniques for the treatment of various spinal conditions have emerged. Surgical techniques have evolved along with advances in operative technology, thus allowing the spinal surgeon the ability to access the spine and perform complicated procedures in a relatively less traumatic fashion as compared with traditional “open” procedures. Data has shown that minimally invasive approaches to the spine decreases the amount of trauma imparted to tissue, reduces operative blood loss, shortens hospital stay, and decreases postoperative pain. In the most experienced hands, this approach to spine surgery decreases the operative time as well. All of these factors have contributed to the popularity of this approach to the spine, as both patients and practitioners have a shared interest in improved outcomes. In the interest of expanding upon the rapidly evolving field of minimally invasive spinal techniques, we have assembled a group of experts in the field of this niche of spinal surgery to write about specific techniques, indications, and technologies that have continued to propel the study of this topic forward. These specialists have a shared interested in progressing the field of spine surgery toward innovation, safety, and improved patient outcomes. The emphasis on surgical technique and preparation, along with other pearls and pitfalls of each procedure, illustrate the high level of expertise needed to perform these technically demanding cases. To assemble this group of spinal surgeons, among them being leaders in the field, has been both a great honor and privilege. Our collective hopes are that this work will train and educate future spinal surgeons and patients about the innovative ways to treat spinal conditions. Also, we hope that in the future the work done today will serve as a platform for even greater advances in technology, the surgical treatment of spinal disorders, and even greater strides toward patient care and safety.