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Posterior Approaches to the Thoracolumbar Spine: Open Versus MISS

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Handbook of Spine Technology

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Abstract

The traditional open approach to the thoracolumbar spine remains one of the most powerful and widely practiced approaches in all of spine surgery. Over the past 2 decades or so, minimally invasive options have gained increasing traction and have been associated with reduced blood loss, paraspinal musculature disruption, infection rates, and length of stay, as well as hospitalization costs, without compromising clinical outcomes or radiographic fusion rates. The minimally invasive approach is not necessarily appropriate for all patients and pathologies, and the two approaches are not mutually exclusive. Currently an array of open and minimally invasive options exist for posterior thoracolumbar fusion, including midline and paramedian approaches, conventional and tubular retractors, posterior and transforaminal interbody as well as posterolateral fusion options, static and expandable cages, and various fixation systems, including pedicle (both open and percutaneous) and cortical bone trajectory screws. More recently, endoscopic spine surgery has garnered growing attention as an ultra minimally invasive alternative and may yet play a significant role in neural decompression and spinal fusion. Furthermore, advances in navigation, robotics, osteobiologics, and perioperative protocols will hopefully translate into increased safety, efficacy, and reproducibility for posterior thoracolumbar fusion procedures.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Westmead Hospital, Sydney, NSW, Australia

    Yingda Li & Andrew Kam

  2. Department of Neurological Surgery, University of Miami, Miami, FL, USA

    Yingda Li

Authors
  1. Yingda Li
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  2. Andrew Kam
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Editor information

Editors and Affiliations

  1. Neuroscience Institute, Allegheny Health Network, Drexel University, Allegheny General Hospital Campus, Pittsburgh, PA, USA

    Boyle C. Cheng

Section Editor information

  1. Gold Coast Spine, Southport, QLD, Australia

    Matthew N. Scott-Young

  2. Faculty of Health Sciences & Medicine, Bond University, Varsity Lakes, QLD, Australia

    Matthew N. Scott-Young

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Li, Y., Kam, A. (2021). Posterior Approaches to the Thoracolumbar Spine: Open Versus MISS. In: Cheng, B.C. (eds) Handbook of Spine Technology. Springer, Cham. https://doi.org/10.1007/978-3-319-44424-6_89

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