Minimally Invasive Spondylodesis Via Percutaneous Approach with Tubular Retractors

Abstract

Open spondylodesis is one of the largest spinal surgeries and is associated with extensive access trauma. There is sometimes considerable blood loss and not infrequently wound healing problems. In this operation, the use of minimally invasive procedures can therefore reduce the access trauma particularly significantly. Spondylodesis aims to achieve a stable connection of vertebrae for life. This goal is typically achieved with a dorsal transpedicular screw-rod system and the apposition of bone in the disc space or at the facet joints. Only bony fusion of the involved vertebrae can ensure permanent stability, as screw-rod systems alone usually cannot permanently withstand the high load. After about 4–5 years, fatigue fractures of the systems or material loosening occur. Until the end of the 1990s, open dorsoventral, usually two-stage surgery with insertion of an iliac crest span for ventral support was the method of choice for spondylodesis. A reduction in surgical and access trauma was achieved by introducing cages for ventral support. These are filled with local bone from the dorsal spine access area for fusion, eliminating the need for iliac crest removal and the additional trauma of the ventral approach.