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Advances in Minimally Invasive Spine Surgery
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Advances in Minimally Invasive Spine Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (5 December 2023) | Viewed by 10380

Special Issue Editor

Dr. Gabriel C. Tender

E-Mail Website
Guest Editor
Department of Neurosurgery, Louisiana State University, 2020 Gravier Street, Suite 744, New Orleans, LA, USA
Interests: minimally invasive spine surgery; microdiscectomy; TLIF; LLIF; posterior cervical fusion

Special Issue Information

Dear Colleagues,

Spine pathology is widespread and will only become more prevalent with the aging population. Millions of patients undergo spine surgery each year, and minimally invasive techniques have allowed for less blood loss, lower infection rates, and a decreased length of hospital stay. These techniques have been used not only in degenerative cases, but also in trauma, infection, and tumor cases. Despite their advantages, minimally invasive techniques are only used in less than 20% of spine surgery cases. The aim of this Special Issue is to provide a comprehensive overview of the advances in minimally invasive spine surgery techniques, with a particular interest in innovative techniques and technologies. Therefore, spine surgeons are encouraged to submit their clinical studies and research as original articles or reviews to this Special Issue.

Dr. Gabriel C. Tender
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • minimally invasive
  • percutaneous pedicle screws
  • transforaminal lumbar interbody fusion
  • lateral lumbar interbody fusion
  • oblique lumbar interbody fusion
  • microdiscectomy
  • laminectomy
  • posterior cervical fusion

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Published Papers (5 papers)

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Research

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13 pages, 4584 KiB  
Article
Transforaminal Endoscopic Lumbar Lateral Recess Decompression for Octogenarian Patients
by Yong Ahn and Jun-Hyeok Jung
J. Clin. Med. 2024, 13(2), 515; https://doi.org/10.3390/jcm13020515 - 17 Jan 2024
Viewed by 1125
Abstract
The incidence of radiculopathy due to lumbar spinal stenosis has been on the increase in the aging population. However, patients aged ≥ 80 years hesitate to undergo conventional open surgery under general anesthesia because of the risk of postoperative morbidity and adverse events. [...] Read more.
The incidence of radiculopathy due to lumbar spinal stenosis has been on the increase in the aging population. However, patients aged ≥ 80 years hesitate to undergo conventional open surgery under general anesthesia because of the risk of postoperative morbidity and adverse events. Therefore, less invasive surgical alternatives are required for the elderly or medically handicapped patients. Transforaminal endoscopic lumbar lateral recess decompression (TELLRD) may be helpful for those patients. This study aimed to demonstrate the efficacy of TELLRD for treating radiculopathy in octogenarian patients. A total of 21 consecutive octogenarian patients with lumbar foraminal stenosis underwent TELLRD between January 2017 and January 2021. The inclusion criterion was unilateral radiculopathy, which stemmed from lumbar lateral recess stenosis. The pain source was verified using imaging studies and selective nerve blocks. Full-scale lateral canal decompression was performed using a percutaneous transforaminal endoscopic approach under local anesthesia. We found the pain scores and functional status improved significantly during the 24-month follow-up period. The clinical improvement rate was 95.24% (20 of 21 patients) with no systemic complication. In conclusion, endoscopic lateral recess decompression via the transforaminal approach is practical for octogenarian patients. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Spine Surgery)
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12 pages, 2698 KiB  
Article
Assessment of Cement Leakage in Decompressed Percutaneous Kyphoplasty
by Shih-Hao Cheng, Wen-Hsiang Chou, Yu-Chuan Tsuei, William Chu and Woei-Chyn Chu
J. Clin. Med. 2024, 13(2), 345; https://doi.org/10.3390/jcm13020345 - 8 Jan 2024
Viewed by 1162
Abstract
Symptomatic osteoporotic compression fractures are commonly addressed through vertebroplasty and kyphoplasty. However, cement leakage poses a significant risk of neurological damage. We introduced “aspiration percutaneous kyphoplasty”, also known as “decompressed kyphoplasty”, as a method to mitigate cement leakage and conducted a comparative analysis [...] Read more.
Symptomatic osteoporotic compression fractures are commonly addressed through vertebroplasty and kyphoplasty. However, cement leakage poses a significant risk of neurological damage. We introduced “aspiration percutaneous kyphoplasty”, also known as “decompressed kyphoplasty”, as a method to mitigate cement leakage and conducted a comparative analysis with high viscosity cement vertebroplasty. We conducted a retrospective study that included 136 patients with single-level osteoporotic compression fractures. Among them, 70 patients underwent high viscosity cement vertebroplasty, while 66 patients received decompressed percutaneous kyphoplasty with low-viscosity cement. Comparison parameters included cement leakage rates, kyphotic angle alterations, and the occurrence of adjacent segment fractures. The overall cement leakage rate favored the decompressed kyphoplasty group (9.1% vs. 18.6%), although statistical significance was not achieved (p = 0.111). Nonetheless, the risk of intradiscal leakage significantly reduced in the decompressed kyphoplasty cohort (p = 0.011), which was particularly evident in cases lacking the preoperative cleft sign on X-rays. Kyphotic angle changes and the risk of adjacent segment collapse exhibited similar outcomes (p = 0.739 and 0.522, respectively). We concluded that decompressed kyphoplasty demonstrates efficacy in reducing intradiscal cement leakage, particularly benefiting patients without the preoperative cleft sign on X-rays by preventing intradiscal leakage. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Spine Surgery)
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15 pages, 12914 KiB  
Article
Free-Hand MIS TLIF without 3D Navigation—How to Achieve Low Radiation Exposure for Both Surgeon and Patient
by Roberto Doria-Medina, Ulrich Hubbe, Christoph Scholz, Ronen Sircar, Johannes Brönner, Herbert Hoedlmoser and Jan-Helge Klingler
J. Clin. Med. 2023, 12(15), 5125; https://doi.org/10.3390/jcm12155125 - 4 Aug 2023
Viewed by 1186
Abstract
Background: Transforaminal lumbar interbody fusion (TLIF) is one of the most frequently performed spinal fusion techniques, and this minimally invasive (MIS) approach has advantages over the traditional open approach. A drawback is the higher radiation exposure for the surgeon when conventional fluoroscopy (2D-fluoroscopy) [...] Read more.
Background: Transforaminal lumbar interbody fusion (TLIF) is one of the most frequently performed spinal fusion techniques, and this minimally invasive (MIS) approach has advantages over the traditional open approach. A drawback is the higher radiation exposure for the surgeon when conventional fluoroscopy (2D-fluoroscopy) is used. While computer-assisted navigation (CAN) reduce the surgeon’s radiation exposure, the patient’s exposure is higher. When we investigated 2D-fluoroscopically guided and 3D-navigated MIS TLIF in a randomized controlled trial, we detected low radiation doses for both the surgeon and the patient in the 2D-fluoroscopy group. Therefore, we extended the dataset, and herein, we report the radiation-sparing surgical technique of 2D-fluoroscopy-guided MIS TLIF. Methods: Monosegmental and bisegmental MIS TLIF was performed on 24 patients in adherence to advanced radiation protection principles and a radiation-sparing surgical protocol. Dedicated dosemeters recorded patient and surgeon radiation exposure. For safety assessment, pedicle screw accuracy was graded according to the Gertzbein–Robbins classification. Results: In total, 99 of 102 (97.1%) pedicle screws were correctly positioned (Gertzbein grade A/B). No breach caused neurological symptoms or necessitated revision surgery. The effective radiation dose to the surgeon was 41 ± 12 µSv per segment. Fluoroscopy time was 64 ± 34 s and 75 ± 43 radiographic images per segment were performed. Patient radiation doses at the neck, chest, and umbilical area were 65 ± 40, 123 ± 116, and 823 ± 862 µSv per segment, respectively. Conclusions: Using a dedicated radiation-sparing free-hand technique, 2D-fluoroscopy-guided MIS TLIF is successfully achievable with low radiation exposure to both the surgeon and the patient. With this technique, the maximum annual radiation exposure to the surgeon will not be exceeded, even with workday use. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Spine Surgery)
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9 pages, 5603 KiB  
Article
The Use of Ultrasonic Bone Scalpel (UBS) in Unilateral Biportal Endoscopic Spine Surgery (UBESS): Technical Notes and Outcomes
by Sung Huang Laurent Tsai, Chia-Wei Chang, Tung-Yi Lin, Ying-Chih Wang, Chak-Bor Wong, Abdul Karim Ghaith, Mohammed Ali Alvi, Tsai-Sheng Fu and Mohamad Bydon
J. Clin. Med. 2023, 12(3), 1180; https://doi.org/10.3390/jcm12031180 - 2 Feb 2023
Cited by 5 | Viewed by 3698
Abstract
Study Design: Case Series and Technical Note, Objective: UBS has been extensively used in open surgery. However, the use of UBS during UBESS has not been reported in the literature. The aim of this study was to describe a new spinal surgical technique [...] Read more.
Study Design: Case Series and Technical Note, Objective: UBS has been extensively used in open surgery. However, the use of UBS during UBESS has not been reported in the literature. The aim of this study was to describe a new spinal surgical technique using an ultrasonic bone scalpel (UBS) during unilateral biportal endoscopic spine surgery (UBESS) and to report the preliminary results of this technique. Methods: We enrolled patients diagnosed with lumbar spinal stenosis who underwent single-level UBESS. All patients were followed up for more than 12 months. A unilateral laminotomy was performed after bilateral decompression under endoscopy. We used the UBS system after direct visualization of the target for a bone cut. We evaluated the demographic characteristics, diagnosis, operative time, and estimated blood loss of the patients. Clinical outcomes included the visual analog scale (VAS), the Oswestry Disability Index (ODI), the modified MacNab criteria, and postoperative complications. Results: A total of twenty patients (five males and fifteen females) were enrolled in this study. The mean follow-up period was 13.2 months (range 12–17 months). The VAS score, ODI, and modified MacNab criteria classification improved after the surgery. A minimal mean blood loss of 22.1 mL was noted during the operation. Only one patient experienced neuropraxia, which resolved within 2 weeks. There was no durotomy, iatrogenic pars fracture, or infection. Conclusions: In conclusion, our study represents the first report of the use of UBS during UBESS. Our findings demonstrate that this technique is safe and efficient, with improved clinical outcomes and minimal complications. These preliminary results warrant further investigation through larger clinical studies with longer follow-up periods to confirm the effectiveness of this technique in the treatment of lumbar spinal stenosis. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Spine Surgery)
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Review

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16 pages, 6015 KiB  
Review
Pars Interarticularis Fractures Treated with Minimally Invasive Surgery: A Literature Review
by Adrienne Minor, Benjamin R. Klein, Mareshah N. Sowah, Kayla Etienne and Allan D. Levi
J. Clin. Med. 2024, 13(2), 581; https://doi.org/10.3390/jcm13020581 - 19 Jan 2024
Cited by 1 | Viewed by 2411
Abstract
Recurrent stress on the isthmic pars interarticularis often leads to profound injury and symptom burden. When conservative and medical management fail, there are various operative interventions that can be used. The current review details the common clinical presentation and treatment of pars injury, [...] Read more.
Recurrent stress on the isthmic pars interarticularis often leads to profound injury and symptom burden. When conservative and medical management fail, there are various operative interventions that can be used. The current review details the common clinical presentation and treatment of pars injury, with a special focus on the emerging minimally invasive procedures used in isthmic pars interarticularis repair. PubMed and Google Scholar database literature reviews were conducted. The keywords and phrases that were searched include but were not limited to; “history of spondylolysis”, “pars interarticularis”, “pars defect”, “conventional surgical repair of pars”, and “minimally invasive repair of pars”. The natural history, conventional presentation, etiology, risk factors, and management of pars interarticularis injury are discussed by the authors. The surgical interventions described include the Buck’s repair, Morscher Screw-Hook repair, Scott’s Wiring technique, and additional pedicle screw-based repairs. Minimally invasive techniques are also reviewed, including the Levi technique. Surgical intervention has been proven to be safe and effective in managing pars interarticularis fractures. However, minimally invasive techniques often provide additional benefit to patients such as reducing damage of surrounding structures, decreasing postoperative pain, and limiting the time away from sports and other activities. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Spine Surgery)
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