Invasive Spine Surgery Research Articles

Endoscope-based hybrid navigation system for minimally invasive ventral spine surgeries

The availability of high-resolution, magnified, and relatively noise-free endoscopic images in a small workspace, 4–10 cm from the endoscope tip, opens up the possibility of using the endoscope as a tracking tool. We are developing a hybrid navigation system in which image-analysis-based 2D–3D tracking is combined with optoelectronic tracking (Optotrak®) for computer-assisted navigation in laparoscopic ventral spine surgeries. Initial results are encouraging and confirm the ability of the endoscope to serve as a tracking tool in surgical navigation where sub-millimetric accuracy is mandatory.

Ultrasonic bone curettes in spinal surgery

Although the development of high-speed drills, in addition to an operating microscope, has greatly improved the techniques and results of spinal surgery, we are always confronted with a risk of neural or vascular injury when using drills in the spine. Ultrasonic surgical aspirators, which have been used mainly for removal of soft-tissue tumors, now can be used to cut and scrape bony structures with a longitudinal and torsional (LT) tip, which has vertical and twisted vibrations, in skull base and spinal surgeries. Recently, we introduced the ultrasonic surgical aspirator system Sonopet OST-2001 with LT tips and lightweight handpieces in 36 cases of various spinal surgeries such as anterior approaches and laminoplasty for cervical spondylosis and OPLL, and partial laminectomy for lumbar stenosis. We found that these ultrasonic bone curettes were a safe and effective alternative to the drills when working adjacent to the dura, nerves and vessels, since it did not have a risk of kicking, which could damage the nearby soft tissues. However, in order to effectively use it through a narrow and deep space under the microscope, the tips and handpieces should be further refined and adjusted for less invasive spinal surgery.

腰椎症の病態と手術 : 低侵襲手術の立場から

低侵襲手術の観点から変性性腰椎疾患につき検討した.本論文では,病変部位を絞り込んだ手術,腰椎麻酔法の採用,腰椎固定術での考慮,の3点につき論じた.低侵襲の腰椎手術を行うためには,詳細な神経学的検査の実施と,各種画像検査所見の厳密な解析を必要とする.本論文では代表的な疾患として腰部脊柱管狭窄症を取り上げ,この病態に対する術式の変遷につき紹介した,大部分の腰椎手術は腰椎麻酔下に安全に実施し得るものであり,心肺機能が低下して全身麻酔のリスクが高い患者でも,腰椎麻酔であれば,有効な手術が可能であることを示した.腰椎固定術は,本来的に侵襲の大きい術式である.腰椎固定術においては,神経根の損傷や傍脊柱筋の損傷が時にみられる.低侵襲腰椎手術を行うためには,固定法の適応や術式の選択に際して細心の配慮が必要である.

Minimally invasive approach and surgical procedures in the lumbar spine

The history of minimally invasive lumbar spine surgery began in 1963 with the introduction of chemonucleolysis. Like this technique, the later development of mechanical nucleotomy and lasernucleotomy aimed primarily at reduction of the disc pressure. Miniature optical systems offered the opportunity for more specific decompression by discoscopy or, more recently, by transforaminal epiduroscopy. Initially, nucleotomy was the only feasible minimally invasive procedure. In recent years, however, minimally invasive spinal fusion became possible due to the development of new devices (Cages) and advanced transperitoneal (laparoscopic) and retroperitoneal approaches.