Percutaneous Vertebroplasty in Osteoporotic Vertebral Fractures. Microsurgical Open Vertebroplasty and Kyphoplasty.
Disc Reconstruction. Spinal Stenosis.
Subject Index. A Short Introduction. Mayer Lumbar Spine. Michael Mayer. The reduction in trauma has been shown to reduce immediate negative effects, such as pain and disability, but not long-term outcomes, says Brett A. Freedman, M. There are no long-term outcomes reported in the literature where minimally invasive techniques led to a better end result than traditional approaches," he says.
Norwegian researchers confirmed the equivalence of the clinical effectiveness of the two procedures in a multicenter observational study published in The BMJ in Using prospective data from a large national spine surgery registry, they compared outcomes for more than patients who had undergone open laminectomy or microdecompression for stenosis of the lumbar spine.
Favorable outcomes, as measured by change in the Oswestry Disability Index, were equivalent at one year. Complication rates and length of surgery were also similar after propensity matching, but patients who underwent microdecompression had consistently shorter hospital stays. At Mayo Clinic, minimally invasive approaches are used when indicated.
But Dr. Freedman cautions that it is far more important to perform all the functions necessary to fully and safely decompress the nerves than to worry about the method used to expose them. You need to be able to see what you need to see.
Otherwise, MISS becomes a mistake. Spinal fusion has been used to manage a variety of disorders of the lumbar spine, including tumors, spinal instability, deformity and stenosis. But traditional open anterior or posterior surgery requires extensive soft tissue dissection to expose the anatomic landmarks for screw insertion, achieve a proper screw trajectory and develop an acceptable fusion bed.
The tissue injury that occurs is not only associated with increased postoperative pain and a lengthy recovery time but also with significant complications. Anterior surgery requires a relatively morbid incision and may cause vascular complications, postoperative colonic obstruction or injury to the sympathetic chain.
Posterior surgery, including posterolateral fusions, posterior lumbar interbody fusions and transforaminal lumbar interbody fusions, can lead to dural tears and neural complications such as radiculitis. In these cases, as well as those where minimally invasive techniques are used, surgical navigation may potentially allow for a more accurate and secure implant placement compared to procedures without intraoperative planning.
Surgeons can also react and verify intra-operatively and, if necessary, correct performed treatment steps during surgery. Accurate placement and stability of spinal implants is critical to overall back function and can potentially help the implant to last longer.
In other spine surgeries, like tumor removal, image guidance systems offer powerful software that helps to outline, or contour, the tumor as well as critical surrounding structures, like nerves and the spinal column. The application of image guidance navigation techniques to address simple or complex pathologies has translated into better outcomes and faster recovery in all areas of the spine.
Fluoroscopy-Based Image-Guided Surgery Fluoroscopy is an imaging method that is useful and familiar to musculoskeletal surgeons. Bolger C, Wigfield C. Minimally invasive approaches can spare these tissues and reduce collateral damage. In particular, the surgical region of interest should be centered in the fluoroscopic image field of view to minimize the effects of parallax. In conventional diskectomy, for example, the paraspinal muscles are dissected from the posterior aspect of the lumbar spine and portions of the lamina are removed to gain access to the spinal canal. Fluoroscopy as an imaging means for Computer-assisted surgical navigation. Microsurgical approaches and endoscopic principles are very well covered for the thoracic and lumbar spine.
The Concerns with Intraoperative Fluoroscopic Imaging Traditionally, doctors doing spine surgeries used a type of medical imaging called intraoperative fluoroscopy. The fluoroscopy images are used to help guide and localize the spine instruments for fusion procedures. However, the X-rays used can be considered hazardous radiation exposure that affects patients, surgeons and O. During minimally invasive spine surgeries MISS , surgeons rely even more on intraoperative fluoroscopy to help guide their instruments.
The advent of surgical navigation and newer intraoperative imaging technologies like cone beam CT and CT have helped decrease the exposure and effects of fluoroscopic radiation. Visit our What is Intraoperative Imaging tab in this same section to explore additional spinal surgery technologies.
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Talk to your neurosurgeon or orthopedic surgeon to find out if image guided spine surgery is an option for you.