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Minimally invasive spine surgery: systematic review

Abstract

Minimally invasive procedures in spine surgery have undergone significant development in recent times. These procedures have the common aim of avoiding biomechanical complications associated with some traditional destructive methods and improving efficacy. These new techniques prevent damage to crucial posterior stabilizers and preserve the structural integrity and stability of the spine. The wide variety of reported minimally invasive methods for different pathologies necessitates a systematic classification. In the present review, authors first provide a classification system of minimally invasive techniques based on the location of the pathologic lesion to be treated, to help the surgeon in selecting the appropriate procedure. Minimally invasive techniques are then described in detail, including technical features, advantages, complications, and clinical outcomes, based on available literature.

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Abbreviations

ALIF:

Anterior lumbar interbody fusion

BLBD:

Bilateral laminotomy for bilateral decompression

DLIF:

Direct lateral interbody fusion

MED:

Microendoscopic discectomy

miPLIF:

Minimally invasive posterior lumbar interbody fusion

MISST:

Minimally invasive spine surgery technique

miTLIF:

Minimally invasive transforaminal lumbar interbody fusion

PED:

Percutaneous endoscopic discectomy

PEEK:

Poly-Ether-Ether-Ketone

PLDD:

Percutaneous laser disc decompression

PLIF:

Posterior lumbar interbody fusion

TLIF:

Transforaminal lumbar interbody fusion

ULBD:

Unilateral laminotomy for bilateral decompression

XLIF:

Extreme lateral interbody fusion

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Acknowledgments

The authors are indebted to Zsófia Perjés M.D. for the excellent illustrations.

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Correspondence to Péter Banczerowski.

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Tamas Doczi, Pecs, Hungary

The goals of minimally invasive spine surgery are (1) to avoid biomechanical complications inherent in traditional destructive techniques and (2) to improve the efficacy of surgical management of various spinal diseases. The purpose is aimed to be achieved by avoiding structural damage to crucial posterior stabilizing elements and by preserving both anatomical integrity and stability of the spine. The aim of this manuscript is to formulate a systematic classification of various minimally invasive methods previously reported that were applied for different pathologies. The authors also claim that the manuscript shall help spinal surgeons in the selection of the appropriate approach or procedure. To achieve these goals, minimally invasive techniques have been described in details including technical features, advantages, complications, and clinical outcomes based on personal experience and available literature. As an overview, it is not an original study in terms of setting first a hypothesis then trying to prove or disprove the concept with facts and figures that are based on either own data or on those collected from literature search. It is a description of available surgical techniques and creation of a system according to the authors’ personal view. It is rather questionable whether the manuscript can really help spinal surgeons in the selection of the appropriate procedure in an individual case. As a trial of setting a nomenclature for spinal surgeons in the field of minimally invasive surgery, this manuscript well deserves publication.

Sandro M. Krieg, Bernhard Meyer, Munich, Germany

Nowadays, spine surgeons have a large armamentarium of procedures and treatment options at hand, which also include various minimally invasive procedures. It is therefore highly welcomed that the present review offers not only an overview but also the recommendation for a classification system of minimally invasive techniques. The targets of this article are two different types of surgeons: experienced spine surgeons who might get another view on some of their own surgical approaches and junior surgeons who need a structured overview for daily decision-making processes.

However, a very wide variety of approaches is presented and some quantification concerning the frequency of use or applicability as well as actual percentages of treatment success or complications seem desirable. Moreover, the characterization and choice of references concerning endoscopic techniques are highly biased and do not mirror daily routine or the current state of evidence. This accords also to laser techniques. More critical statements from an evidence-based point of view would increase the value of this article. Moreover, in the age of increasing use of posterior dynamic stabilization by screw-rod systems, this option deserves at least some notice in a systematic overview.

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Banczerowski, P., Czigléczki, G., Papp, Z. et al. Minimally invasive spine surgery: systematic review. Neurosurg Rev 38, 11–26 (2015). https://doi.org/10.1007/s10143-014-0565-3

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  • DOI: https://doi.org/10.1007/s10143-014-0565-3

Keywords

  • Minimally invasive
  • Spine surgery
  • Surgical approach
  • Endoscopic procedure
  • Percutaneous technique
  • Interspinous device
  • Interbody fusion