Novel Minimal Invasive Surgical Techniques for the Treatment of Segmental-Lateral Pathologic Lesions of the Spine

Abstract

Introduction Laminectomy, commonly used dorsal approach for the surgical removal of most of the pathologic lesions, situated in the spinal canal and the neuroforamen destroying the dorsal stabilizing structures of the spinal column. Retraction and detachment of the longitudinal muscles, removal of the vertebral arches (laminectomy), and injury of the joint capsules and ligaments are responsible most of short and late-time complications. Among these complications, spinal deformities, segmental instability, and permanent spinal pain are most often mentioned in the literature. The main objective of the authors was to develop and evaluate the novel minimally invasive techniques suitable for exploring and treating different segmental-lateral pathologies, expanding to the neuroforamen or even paravertebrally, with preservation of the stability of the spine. One of the key issues of this article was to summarize these procedures, with evaluating the safety and efficacy in the routine spine surgery. Patients and Methods A total of 167 patients were operated and followed up during 2000 to 2011 in our Institute with segmental lateral spinal pathologies. For the surgical treatment, we used “Over-the-top” decompression, hemi–semi laminectomy, supraforaminal burr-hole, open-tunnel, and paravertebral approaches alone or in combination. These surgical techniques are mostly our developments, or modifications of previously used surgical techniques. Results The new surgical procedures developed or modified by our team are effective techniques for treating the spinal pathologies located in the spinal canal, neuroforamen, or even the paravertebral space. The posterior stabilizing structures of the spine, as the vertebral laminae and the longitudinal musculature are mostly preserved. Leaving the longitudinal paraspinal musculature innervations intact, and with the preservation of the bone–muscle attachments and ligaments, the dynamic stability of the spine remains unchanged. Retaining the bony structures (vertebral arches) and the vertebral joints the static stability of the spinal column remain intact, the chance of developing the long-term spinal deformation is minimal. During the follow-up, we performed static and dynamic X-ray, MR, and CT scans, completed with neurological examinations to evaluate the progression of the illness, the neurological deficit, and the actual state of the spinal column. With clinical use and evaluation of the various surgical approaches, we determined the main indications and contraindications of the surgical procedures, highlighting the pit-falls and limitations. Conclusion The aforementioned minimally invasive surgical approaches are suitable for treating segmental–lateral spinal pathologies. For the routine clinical use, we organized the surgical techniques into a complete framework based on the location of the pathologic lesions.