Minimally Invasive Spine Surgery Research Articles

Lumbar Spinal Stenosis: Ipsilateral Facet-sparing Unilateral Laminotomy for Bilateral Decompression: Technical Note and Preliminary Results

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Minimally Invasive Surgery vs. Open Surgery for Infectious Spondylodiscitis: A Systematic Review and Meta-Analysis

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Transforaminal Endoscopic Partial Vertebrectomy for Decompression of Spinal Metastases: A Novel, Minimally Invasive Approach to Treating Symptomatic Lumbar Vertebral Body Metastases

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Biomechanical Evaluation of the Effect of Minimally Invasive Spine Surgery Compared with Traditional Approaches in Lifting Tasks.

Fusion of spinal vertebrae can be accomplished by different surgical approaches. We investigated Traditional Open Spine Surgery (TOSS) versus Minimally Invasive Spine Surgery (MISS). While TOSS sacrifices spine muscles originating or inserting on the affected vertebrae, MISS seeks to minimize the approach-related morbidity and preserve the tendon attachments of the muscles in the area. We captured 3-D motions of the full body of one healthy subject performing a variety of 10 kg box lifting operations representing activities-of-daily-living that are likely to challenge the spine biomechanically. The motion data were transferred to a full-body biomechanical model with a detailed representation of the biomechanics of the spine, and simulations of the internal spine loads and muscle forces were performed under a baseline configuration and muscle configurations typical for TOSS respectively MISS for the cases of L3/L4, L4/L5, L5/S1, L4/S1 and L3/L5 fusions. The computational model was then used to investigate the biomechanical differences between surgeries. The simulations revealed that joint reaction forces are more affected by both surgical approaches for lateral lifting motions than for sagittal plane motions, and there are indications that individuals with fused joints, regardless of the approach, should be particularly careful with asymmetrical lifts. The MISS and TOSS approaches shift the average loads of different muscle groups in different ways. TOSS generally leads to higher post-operative muscle loads than MISS in the investigated cases, but the differences are smaller than could be expected, given the differences of surgical technique.

Letter to the Editor Regarding “Biportal Endoscopic Spinal Surgery Versus Microscopic Decompression for Lumbar Spinal Stenosis—A Systematic Review and Meta-analysis”

Letter to the Editor Regarding “Biportal Endoscopic Spinal Surgery Versus Microscopic Decompression for Lumbar Spinal Stenosis—A Systematic Review and Meta-analysis”

Syringopleural Shunt Insertion Using a Minimally Invasive Approach: Technical Note, Case Series, and Review of the Literature

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Clinical Comparison of Low and High Injection Volumes of High-viscosity Bone Cement Used in Percutaneous Vertebroplasty

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Direct Anterior Screw Fixation in a Type II Odontoid Fracture with a Fused C2–C3: A Technical Report

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Osteoporotic Fractures of Thoracolumbar Spine with Neurodeficit: Radiological Instability Scoring and Minimally Invasive Stabilization

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Alleviating Paravertebral Muscle Spasm after Radiofrequency Ablation Treatment of Hypersensitive Basivertebral and Sinuvertebral Nerves for Chronic Discogenic Back Pain

Paraspinal muscle spasm caused by pain from a lumbar degenerative disc is frequently investigated in patients with low back pain. Radiofrequency ablation (RFA) surgery could alleviate paraspinal muscle spasms. We performed RFA surgery on the high-intensity zone (HIZ) and hypersensitive sinuvertebral and basivertebral nerves to evaluate its outcome. The paravertebral muscle cross-sectional area (CSA) was measured on magnetic resonance imaging (MRI) before and after surgery to evaluate the effect of RFA surgery on the paravertebral muscle. Prospective cohort study. A single spine surgery center. A comparative study was performed on 2 different uniportal spinal endoscopic surgery groups; 23 patients who underwent RFA surgery for chronic discogenic back pain and 45 patients who underwent posterior decompression surgery for lumbar spinal stenosis with 12 months of follow-up. Paravertebral muscle cross-sectional area, Schiza grade, Modic type, and HIZ size were measured on pre- and post-operative MRI. An endoscopic video review was performed to evaluate the presence of intraoperative twitching and grade the degree of epidural neovascularization and adhesion. Visual analog scale VAS, modified Oswestry Disability Index, ODI and MacNab's criteria were evaluated for outcome measures. Intraoperative endoscopic video evaluation showed neovascularization and adhesion adjacent to the disc and pedicle. In the RFA surgery group, there were 7 patients (30.43%) with grade 2 and 16 (69.57%) with grade 3 neovascularization; intraoperative twitching was observed in 19 out of 23 patients (82.61%). After performing an RFA on the sinuvertebral and basivertebral nerves for the treatment of discogenic back pain, the results showed significant improvement in pain and disability scores. The mean CSA of the paraspinal muscle in the RFA surgery group was significantly increased after surgery at the L4-L5 and L5-S1 levels (L4-L5: 3901 ± 1096.7 mm² to 4167 ± 1052.1 mm², P = 0.000; L5-S1: 3059 ± 968.5 mm² to 3323 ± 1046.2 mm², P = 0.000) compared to preoperative CSA. This study was limited by its small sample size. Hypersensitive sinuvertebral and basivertebral nerves are strongly associated with epidural neovascularization with adhesion and the pathological pain pathway in degenerative disc disease. Epidural neovascularization with adhesion reflects aberrant neurological connections, which are associated with reflex inhibitory mechanisms of the multifidus muscle, which induces spasm. RFA treatment of the region of epidural neovascularization with adhesion effectively treated chronic discogenic back pain and could induce paraspinal muscle spasm release.

Analysis of risk factors for perioperative hidden blood loss in unilateral biportal endoscopic spine surgery: a retrospective multicenter study

BackgroundHidden blood loss (HBL) represents an important complication of unilateral biportal endoscopic (UBE) spine surgery. This study aimed to evaluate HBL and its possible risk factors among patients undergoing UBE surgery for lumbar degenerative diseases.MethodsThis multicentric retrospective study was conducted in 3 different medical centers between July 2020 and April 2021. Data of patients who underwent UBE surgery were extracted by electronic medical record system. The patient’s demographic characteristics and blood loss-related parameters were recorded. We calculated the amount of HBL and explored the association between patient’s characteristics and HBL using Pearson or Spearman correlation analysis. Multivariate linear regression analysis was conducted to identify independent risk factors of HBL.ResultsA total of 136 patients (55 females and 81 males, age range 43 to 74 years) were included in this study. A substantial amount of HBL (469.5 ± 195.3 ml, 57.6% of TBL, total blood loss) occurred following UBE surgery. Multiple linear regression analysis indicated that the risk factors of HBL were as follows: age (P = 0.000), number of fusion levels (P = 0.015), American Society of Anesthesiologists (ASA) classification (P = 0.046), surgery time (P = 0.017), patient’s blood volume (PBV, P = 0.026), total blood loss (TBL, P = 0.001), postoperative (i.e., day 2 or 3) hematocrit (Hct, P = 0.034), Hct loss (P = 0.005), and fibrinogen (P = 0.028).ConclusionsA certain amount of HBL occurs in UBE surgery and cannot be ignored in daily clinical practice. The age, number of fusion levels, ASA classification, surgery time, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen are independent risk factors for HBL.

[Progress in minimally invasive spinal surgery for spinal metastases].

With the recent advances in tumor treatments,the prognosis of patients with malignancies have been greatly improved.The strategy of surgical treatments for spinal metastases has drawn wide attention.Compared with traditional open surgery,minimally invasive spine surgery (MISS) results in similar outcomes,less trauma and more rapid recovery.For patients with spinal metastases,shorter recovery time permits earlier postoperative radiotherapy,achieving better tumor control.This paper discussed the application of MISS in the treatments of spinal metastases in terms of the concept,surgical purpose,indications and surgical options of MISS,hoping to provide reference for clinical practice.

Application of a Novel Attachable Magnetic Nerve Stimulating Probe in Intraoperative Lumbar Pedicle Screw Placement: A Porcine Model Study

Pedicle screw instrumentation is a fundamental technique in lumbar spine surgery. However, several complications could occur when placing a pedicle screw, the most serious being damage to the neural structures. We developed an attachable magnetic nerve stimulating probe used for triggered electromyography (t-EMG) to avoid these. This study aimed to investigate the efficacy of this probe for intraoperative neuromonitoring (ION) during lumbar pedicle screw placement in a porcine model. Forty pedicle screws were inserted bilaterally into the pedicles of the fourth and fifth lumbar vertebrae of five pigs; 20 were inserted typically into the pedicle without nerve damage (Group A), and the other 20 were inserted through the broken medial wall of the pedicle to permit contact with the neural structures (Group B). We measured the triggered threshold for pedicle screw placement through the conventional nerve probe and our newly developed magnetic probe. There was no significant difference in the triggered threshold between the two instruments (p = 0.828). Our newly developed magnetic stimulating probe can be attached to a screwdriver, thus preventing real-time screw malpositioning and making it practical and equally safe. This probe could become indispensable in revision spine surgeries with severe adhesions or endoscopic spine surgeries.

Complication management in minimally invasive spinal surgery

Minimally invasive spine surgery (MIS) allows for the treatment of spinal abnormalities with considerably decreased soft tissue disruption and post-operative pain which has been associated with shorter hospitalizations and earlier mobilization. However, MIS procedures have a steep learning curve, offer decreased visualization, and require more advanced technical proficiency which may lead to the occurrence of a technical complication. This review examines common complications associated with various MIS procedures and provides suggestions for risk mitigation and complication management.

P20. Predisposing risk factors of the facet joint violation in the lumbar spinal fusion during the instrumentation of minimal invasive spinal surgery

<h3>BACKGROUND CONTEXT</h3> Trending of minimal invasive surgery is increased and adjacent segmental degeneration is the one of the complications sequentially from the procedures which the facet joint injury is one of the causes. The patients who have ASD have vary symptoms such as back pain, neurological compression and instability and some of them required the second or third operation. The facet joint violation can occur during the instrumentation which the surgeons had known the facet joint indirectly visualization. Risk factors of the facet joint violation have the many considerations such as the patient characteristics, facet anatomy, surgical techniques and radiographic assisted. <h3>PURPOSE</h3> Identify the risk factors which have affected the facet joint violation during the minimal invasive spinal surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective study which is an analysis of 119 patients who have had the minimal invasive spinal surgery from June 2018 to December 2019. <h3>PATIENT SAMPLE</h3> A total of 119 patients who have had the minimal invasive lumbar spinal surgery with percutaneous pedicular screw placed from June 2018 to December 2019. All patients had the CT and MRI scan postoperatively within 6 months after the operation will include to our study. <h3>OUTCOME MEASURES</h3> Facet joint violation at the uppermost level was examined by the CT scan in all dimensions. The facet joint violation defined as the instrument was breeched into the facet joint. We classified these findings as in the facet violation group. The none violation was classified into non-facet violation group. Radiographic parameters (Facet diameter, facet angle, pedicle angle, screw-facet angle, screw-endplate angle and distance between head of screws and facet) were measured. BMI, age, diagnosis and navigation-assisted were included. Risk factor were analyzed and determined which factor have had an effect to the facet joint violation and scoring system for the risk factor was calculated. <h3>METHODS</h3> This study is an analysis of 119 patients who have had the minimal invasive spinal surgery from June 2018 to December 2019. Facet joint violation at the uppermost level was examined by the CT scan in all dimensions. Radiographic parameters (Facet diameter, facet angle, pedicle angle, screw-facet angle, screw-endplate angle and distance between head of screws and facet) were measured. BMI, age, diagnosis and navigation-assisted were included. Risk factor were analyzed and determined which factor have had an effect to the facet joint violation and scoring system for the risk factor was calculated. <h3>RESULTS</h3> A total of 119 patients, 36 males and 83 females, patients mean age was 63 years old, diagnosis was 38 patients had SCS, 54 patients had spondylolisthesis, 17 had HNP, 4 had degenerative scoliosis and 6 had degenerative disc disease. Facet violation was determined 1 patient at L1, 3 patients at L2, 20 patients at L3, 79 patients at L4 and 16 patients at L5. Facet joint violation occurred in 13/119(10.9%) and 15/238(6.3%) joints. No facet joint violation occurred in 60 patients who navigation-assisted was used, versus 15/178(8.4%) joints where there was no navigation(P=0.01). We found an increasing proportion of violations as the lumbar level increased: no violations occurred in 8 patients with lumbar at L1 or L2, 1/40(2.5%), 7/158(4.4%) and 7/32 (21.9%) of violations occurred at L3, L4 and L5, respectively (P=0.01). Although it was not statistically significant, the percentage of violations was higher in patients with scoliosis (12.5%) and DDD (16.7%). Diameter of facet in axial cut, facet angle, screw facet angle and distance between head of screw and facet was statistically significant to determine increasing rate of facet joint violations after multivariable analysis was done (AROC=0.9486, P≤0.05). <h3>CONCLUSIONS</h3> Increasing of the facet diameter in axial plane, facet angle, screw facet angle and distance between dome of screw and facet are one of the risk factor of facet joint violation. Surgeon can avoid the violation when the radiographic consideration was done. Careful screw placement and make the good entry points for instrumentation will decrease rate of facet violation. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Decompression Using Minimally Invasive Surgery for Lumbar Spinal Stenosis Associated with Degenerative Spondylolisthesis: A Review.

Lumbar spinal stenosis (LSS), which often occurs concurrently with degenerative spondylolisthesis (DS), is a common disease in the elderly population, affecting the quality of life of aged people significantly. Notwithstanding the frequently good effect of conservative therapy on LSS, a minority of the patients ultimately require surgery. Surgery for LSS aims to decompress the narrowed spinal canals with preservation of spinal stability. Traditional open surgery, either pure decompression or decompression with fusion, was considered effective for the treatment of LSS with or without DS. However, the long-term clinical outcomes of traditional open surgery are still unclear. Moreover, the disadvantages of conventional open surgery are extensive, examples including tissue injuries or secondary instability, with limited outcomes and significant reoperation rates. With the development and improvement of surgical tools, various minimally invasive spine surgery (MISS) methods, including indirect decompression techniques of interspinous process devices (IPDs) and direct decompression techniques such as microscopic spine surgery or endoscopic spine surgery (ESS), have been updated with enhancement. IPDs, such as Superion devices, were reported to behave with comparable physical function, disability, and symptoms outcomes to laminectomy decompression. As an emerging technique of MISS, ESS has beneficial hallmarks including minimal tissue injuries, reduced complication rates, and shortened recovery periods, thus gaining popularity in recent years. ESS can be classified in terms of endoscopic hallmarks and approaches. Predictably, with the continuous development and gradual maturity, MISS is expected to replace traditional open surgery widely in the surgical treatment of LSS associated with DS in the future.

[Consideration on progressive expanding the indications of percutaneous endoscopic spine surgery].

[Consideration on progressive expanding the indications of percutaneous endoscopic spine surgery].

Development and Validation of a Low-Cost Endoscopic Spine Surgery Simulator.

BackgroundMinimally invasive endoscopic techniques in spine surgery continue to gain in popularity. Unfortunately, there is a long learning period for novice endoscope users to acquire basic skills, and complex training simulators are frequently cost-prohibitive. This paper describes the development and validation of a low-cost endoscopic spine training simulator.MethodologyA low-cost endoscopic spine training model was created utilizing a budget of less than 65 USD. Afterward, a training curriculum consisting of five tasks was designed to mimic standard techniques frequently utilized in endoscopic spine surgery. This curriculum was tested on a cohort of surgical trainees. The initial time to completion as well as errors made during the tasks and repeat trials were recorded. A composite score was generated to quantify the overall scores which included both time and errors in each task.ResultsIn total, 11 students and surgical residents completed the curriculum. The first attempt required an average of 622 seconds for the completion of the curriculum compared to 283 seconds in the second trial (p < 0.001; SD = 36.75). In regards to trials in which errors were counted, fewer errors occurred during the second attempt (2.55 vs. 1.53); however, this difference was not statistically significant (p > 0.05). In regards to the composite score, the composite score of the intern group demonstrated an average improvement of 0.345 compared to an average improvement of 0.47 in the resident group.ConclusionsOur study demonstrates the feasibility of a low-cost endoscopic spine trainer as well as its efficacy in improving basic endoscopic skills in trainees.

Accidental Dural Tears in Minimally Invasive Spinal Surgery for Degenerative Lumbar Spine Disease.

Background: One of the most frequent complications of spinal surgery is accidental dural tears (ADTs). Minimal access surgical techniques (MAST) have been described as a promising approach to minimizing such complications. ADTs have been studied extensively in connection with open spinal surgery, but there is less literature on minimally invasive spinal surgery (MISS).Materials and Methods: We reviewed 187 patients who had undergone degenerative lumbar spinal surgery using minimally invasive spinal fusions techniques. We analyzed the influence of age, Body Mass Index (BMI), smoking, diabetes, and previous surgery on the rate of ADTs in MISS.Results: Twenty-two patients (11.764%) suffered from an ADT. We recommended bed rest for two and a half to 5 days, depending on the type of repair required and the amount of cerebrospinal fluid (CSF) leakage. We could not find any statistically significant correlation between ADTs and age (p = 0.34,), BMI (p = 0.92), smoking (p = 0.46), and diabetes (p = 0.71). ADTs were significantly more frequent in cases of previous surgery (p < 0.001). None of the patients developed a transcutaneous CSF leak or post-operative infection.Conclusions: The frequency of ADTs in MISS appears comparable to that encountered when using open surgical techniques. Additionally, MAST produces less dead space along the corridor to the spine. Such reduced dead space may not be enough for pseudomeningocele to occur, cerebrospinal fluid to accumulate, and fistula to form. MAST, therefore, provides a certain amount of protection.

Minimally Invasive Versus Open Surgery for the Treatment of Types B and C Thoracolumbar Injuries: A PRISMA Systematic Review.

Thoracic and lumbar spine injuries may require surgical management, particularly AO Spine types B and C injuries. Open reduction and fixation using pedicle screws, with or without fusion and/or decompression, is the gold standard surgical treatment for unstable injuries. Recent advances in instrumentation design have resulted in less-invasive surgeries. However, the literature is sparse about the effectiveness of these procedures for types B and C injuries. The objective is to compare the outcomes of conventional open surgery versus minimally invasive spine surgery (MISS) for the treatment of AO Spine types B and C thoracolumbar injuries. A systematic review of published literature in PubMed, Web of Science, and Scopus was performed to identify studies comparing outcomes achieved with open versus minimally invasive surgery in AO Spine types B and C thoracolumbar injury patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Five retrospective case-control studies and 3 prospective studies met selection criteria. In general, most of the studies demonstrated that minimally invasive spine surgery is feasible for types B and C injuries, and associated with potential advantages like reduced blood loss, postoperative pain, and muscle injury, and shorter hospital stays. However, no differences were detected in major outcomes, like neurological status or disability. Published literature currently suggests that minimally invasive spine surgery is a valid alternative for treating types B and C thoracolumbar injuries. However, further comparative prospective randomized clinical trials are necessary to establish the superiority of one approach over the other. 3.