Medicina

Research

17 pages, 4480 KiB

Open AccessArticle

CT-Navigated Spinal Instrumentations–Three-Dimensional Evaluation of Screw Placement Accuracy in Relation to a Screw Trajectory Plan

by Arthur Gubian, Lisa Kausch, Jan-Oliver Neumann, Karl Kiening, Basem Ishak, Klaus Maier-Hein, Andreas Unterberg and Moritz Scherer

Medicina 2022, 58(9), 1200; https://doi.org/10.3390/medicina58091200 - 1 Sep 2022

Cited by 5 | Viewed by 2549

Abstract

Background and Objectives: In the literature, spinal navigation and robot-assisted surgery improved screw placement accuracy, but the majority of studies only qualitatively report on screw positioning within the vertebra. We sought to evaluate screw placement accuracy in relation to a preoperative trajectory plan [...] Read more.

Background and Objectives: In the literature, spinal navigation and robot-assisted surgery improved screw placement accuracy, but the majority of studies only qualitatively report on screw positioning within the vertebra. We sought to evaluate screw placement accuracy in relation to a preoperative trajectory plan by three-dimensional quantification to elucidate technical benefits of navigation for lumbar pedicle screws. Materials and Methods: In 27 CT-navigated instrumentations for degenerative disease, a dedicated intraoperative 3D-trajectory plan was created for all screws. Final screw positions were defined on postoperative CT. Trajectory plans and final screw positions were co-registered and quantitatively compared computing minimal absolute differences (MAD) of screw head and tip points (mm) and screw axis (degree) in 3D-space, respectively. Differences were evaluated with consideration of the navigation target registration error. Clinical acceptability of screws was evaluated using the Gertzbein–Robbins (GR) classification. Results: Data included 140 screws covering levels L1-S1. While screw placement was clinically acceptable in all cases (GR grade A and B in 112 (80%) and 28 (20%) cases, respectively), implanted screws showed considerable deviation compared to the trajectory plan: Mean axis deviation was 6.3° ± 3.6°, screw head and tip points showed mean MAD of 5.2 ± 2.4 mm and 5.5 ± 2.7 mm, respectively. Deviations significantly exceeded the mean navigation registration error of 0.87 ± 0.22 mm (p < 0.001). Conclusions: Screw placement was clinically acceptable in all screws after navigated placement but nevertheless, considerable deviation in implanted screws was noted compared to the initial trajectory plan. Our data provides a 3D-quantitative benchmark for screw accuracy achievable by CT-navigation in routine spine surgery and suggests a framework for objective comparison of screw outcome after navigated or robot-assisted procedures. Factors contributing to screw deviations should be considered to assure optimal surgical results when applying navigation for spinal instrumentation. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

9 pages, 1627 KiB

Open AccessArticle

Minimally Invasive Spine Stabilization for Pyogenic Spondylodiscitis: A 23-Case Series and Review of Literature

by Shinichi Ishihara, Haruki Funao, Norihiro Isogai, Masayuki Ishihara, Takanori Saito and Ken Ishii

Medicina 2022, 58(6), 754; https://doi.org/10.3390/medicina58060754 - 1 Jun 2022

Cited by 3 | Viewed by 4570

Abstract

Background and Objectives: The incidence of pyogenic spondylodiscitis has been increasing due to the aging of the population. Although surgical treatment is performed for refractory pyogenic spondylodiscitis, surgical invasiveness should be considered. Recent minimally invasive spine stabilization (MISt) using percutaneous pedicle screw (PPS) [...] Read more.

Background and Objectives: The incidence of pyogenic spondylodiscitis has been increasing due to the aging of the population. Although surgical treatment is performed for refractory pyogenic spondylodiscitis, surgical invasiveness should be considered. Recent minimally invasive spine stabilization (MISt) using percutaneous pedicle screw (PPS) can be a less invasive approach. The purpose of this study was to evaluate surgical results and clinical outcomes after MISt with PPS for pyogenic spondylodiscitis. Materials and Methods: Clinical data of patients who underwent MISt with PPS for pyogenic spondylitis were analyzed. Results: Twenty-three patients (18 male, 5 female, mean age 67.0 years) were retrospectively enrolled. The mean follow-up period was 15.9 months after surgery. The causative organism was identified in 16 cases (69.6%). A mean number of fixed vertebrae was 4.1, and the estimated blood loss was 145.0 mL. MISt with PPS was successfully performed in 19 of 23 patients (82.6%). Four cases (17.4%) required additional anterior debridement and autologous iliac bone graft placement. CRP levels had become negative at an average of 28.4 days after surgery. There was no major perioperative complication and no screw or rod breakages during follow-up. Conclusions: MISt with PPS would be a less invasive approach for pyogenic spondylodiscitis in elderly or immunocompromised patients. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

9 pages, 881 KiB

Open AccessArticle

Risk Factors for Postoperative Loss of Correction in Thoracolumbar Injuries Caused by High-Energy Trauma Treated via Percutaneous Posterior Stabilization without Bone Fusion

by Ryosuke Hirota, Atsushi Teramoto, Hideto Irifune, Mitsunori Yoshimoto, Nobuyuki Takahashi, Mitsumasa Chiba, Noriyuki Iesato, Kousuke Iba, Makoto Emori and Toshihiko Yamashita

Medicina 2022, 58(5), 583; https://doi.org/10.3390/medicina58050583 - 24 Apr 2022

Cited by 1 | Viewed by 2345

Abstract

Background and Objectives: Percutaneous pedicle screws were first introduced in 2001, soon becoming the cornerstone of minimally invasive spinal stabilization. Use of the procedure allowed adequate reduction and stabilization of spinal injuries, even in severely injured patients. This decreased bleeding and shortened [...] Read more.

Background and Objectives: Percutaneous pedicle screws were first introduced in 2001, soon becoming the cornerstone of minimally invasive spinal stabilization. Use of the procedure allowed adequate reduction and stabilization of spinal injuries, even in severely injured patients. This decreased bleeding and shortened surgical time, thereby optimizing outcomes; however, postoperative correction loss and kyphosis still occurred in some cases. Thus, we investigated cases of percutaneous posterior fixation for thoracolumbar injury and examined the factors affecting the loss of correction. Materials and Methods: Sixty-seven patients who had undergone percutaneous posterior fixation for thoracolumbar injury (AO classifications A3, A4, B, and C) between 2009 and 2016 were included. Patients with a local kyphosis angle difference ≥10° on computed tomography at the postoperative follow-up (over 12 months after surgery) or those requiring additional surgery for interbody fusion were included in the correction loss group (n = 23); the no-loss group (n = 44) served as the control. The degree of injury (injury level, AO classification, load-sharing score, local kyphosis angle, cuneiform deformity angle, and cranial and caudal disc injury) and surgical content (number of fixed intervertebral vertebrae, type of screw used, presence/absence of screw insertion into the injured vertebrae, and presence/absence of vertebral formation) were evaluated as factors of correctional loss and compared between the two groups. Results: Comparison between each group revealed that differences in the wedge-shaped deformation angle, load-sharing score, degree of cranial disc damage, AO classification at the time of injury, and use of polyaxial screws were statistically significant. Logistic regression analysis showed that the differences in wedge-shaped deformation angle, AO classification, and cranial disc injury were statistically significant; no other factors with statistically significant differences were found. Conclusion: Correction loss was seen in cases with damage to the cranial intervertebral disc as well as the vertebral body. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

10 pages, 5998 KiB

Open AccessArticle

Mechanical Study of Various Pedicle Screw Systems including Percutaneous Pedicle Screw in Trauma Treatment

by Yoshiaki Oda, Tomoyuki Takigawa, Yasuo Ito, Haruo Misawa, Tomoko Tetsunaga, Koji Uotani and Toshifumi Ozaki

Medicina 2022, 58(5), 565; https://doi.org/10.3390/medicina58050565 - 20 Apr 2022

Cited by 3 | Viewed by 2431

Abstract

Background and Objectives: Spine surgery using a percutaneous pedicle screw placement (PPSP) is widely implemented for spinal trauma. However, percutaneous systems have been reported to have weak screw–rod connections. In this study, conventional open and percutaneous systems were biomechanically evaluated and compared. [...] Read more.

Background and Objectives: Spine surgery using a percutaneous pedicle screw placement (PPSP) is widely implemented for spinal trauma. However, percutaneous systems have been reported to have weak screw–rod connections. In this study, conventional open and percutaneous systems were biomechanically evaluated and compared. Material and Methods: The experiments were performed in two stages: the first stage was a break test, whereas the second stage was a fatigue test. Four systems were used for the experiments. System 1 was intended for conventional open surgery (titanium rod with a 6.0 mm diameter, using a clamp connecting mechanism). System 2 was a percutaneous pedicle screw (PPS) system for trauma (titanium alloy rod with a 6.0 mm diameter, using ball ring connections). System 3 was a PPS system for trauma (cobalt–chromium alloy rod with a 6.0 mm diameter, using sagittal adjusting screw connections). System 4 was a general-purpose PPS system (titanium alloy rod with a 5.5 mm diameter, using a mechanism where the adapter in the head holds down the screw). Results: Stiffness values of 54.8 N/mm, 43.1 N/mm, 90.9 N/mm, and 39.3 N/mm were reported for systems 1, 2, 3, and 4, respectively. The average number of load cycles in the fatigue test was 134,393, 40,980, 1,550,389, and 147,724 for systems 1 to 4, respectively. At the end of the test, the displacements were 0.2 mm, 16.9 mm, 1.2 mm, and 8.6 mm, respectively. System 1, with a locking mechanism, showed the least displacement at the end of the test. Conclusion: A few PPS systems showed better results in terms on stiffness and life than the open system. The experiments showed that mechanical strength varies depending on the spinal implant. The experiments conducted are essential and significant to provide the mechanical strength required for surgical reconstruction. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

5 pages, 250 KiB

Open AccessArticle

Substantially High Hidden Blood Loss in Oblique Lateral Interbody Fusion: Retrospective Case Series

by Koichiro Shima, Takashi Sono, Toshiyuki Kitaori and Kazutaka Takatsuka

Medicina 2022, 58(4), 527; https://doi.org/10.3390/medicina58040527 - 9 Apr 2022

Cited by 5 | Viewed by 1742

Abstract

Background and Objectives: Measured blood loss frequently underestimates true blood loss; this discrepancy is called hidden blood loss (HBL). The purpose of the present study was to measure HBL in oblique lateral interbody fusion (OLIF). Materials and Methods: Patients who underwent [...] Read more.

Background and Objectives: Measured blood loss frequently underestimates true blood loss; this discrepancy is called hidden blood loss (HBL). The purpose of the present study was to measure HBL in oblique lateral interbody fusion (OLIF). Materials and Methods: Patients who underwent two-stage OLIF at our institute from September 2017 to September 2021 were retrospectively reviewed. Total blood loss (TBL) and HBL were calculated using the gross formula. The age, sex, body mass index (BMI), operation time, measured blood loss, the number of fused segments, hematocrit (HCT), anticoagulant or platelet medication, blood transfusion, days of hospitalization, pre-/postoperative Japanese Orthopedic Association (JOA) score, and JOA recovery rate were compared. Results: A total of thirteen patients were included in the study. The average age, BMI, number of fused segments, operation time, estimated blood loss, and blood transfusion were 69.5 years, 23.3, 2.5, 250 min, 122 mL, and 230 mL, respectively. Five patients received anticoagulant or platelet therapy. Days of hospitalization, pre-/postoperative JOA score, and JOA recovery rate were 14.9 ± 5.1, 19.9 ± 2.7, and 18.0 ± 43.4%, respectively. The TBL and HBL were 688 and 797 mL, respectively. Stepwise multiple regression analysis revealed that younger age (p = 0.01), female sex (p = 0.01), and number of fused segments (p = 0.02) were significantly associated with higher HBL. Conclusions: The HBL in OLIF was 797 mL, which was more than other previously reported procedures. Therefore, OLIF may not be less invasive in terms of HBL. Blood loss after surgery should be considered, especially when patients are younger, are female, and have a greater number of fused segments. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

13 pages, 4205 KiB

Open AccessArticle

Bone Fusion Morphology after Circumferential Minimally Invasive Spine Surgery Using Lateral Lumbar Interbody Fusion and Percutaneous Pedicle Screws without Bone Grafting in the Thoracic Spine: A Retrospective Study

by Masayuki Ishihara, Shinichirou Taniguchi, Koki Kawashima, Takashi Adachi, Masaaki Paku, Yoichi Tani, Muneharu Ando and Takanori Saito

Medicina 2022, 58(4), 496; https://doi.org/10.3390/medicina58040496 - 30 Mar 2022

Cited by 5 | Viewed by 3169

Abstract

Background and Objectives: This study aimed to investigate the process and morphology of thoracic and lumbosacral bone fusion in patients with adult spinal deformity (ASD) who underwent circumferential minimally invasive spine surgery (CMIS) by lateral lumbar interbody fusion (LLIF) and percutaneous pedicle [...] Read more.

Background and Objectives: This study aimed to investigate the process and morphology of thoracic and lumbosacral bone fusion in patients with adult spinal deformity (ASD) who underwent circumferential minimally invasive spine surgery (CMIS) by lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screws (PPSs) without bone grafting in the thoracic spine and who have risk factors for bone fusion failure in the thoracic spine. Materials and Methods: This retrospective study included 61 patients with spinal deformities (46 women and 15 men) who underwent CMIS with LLIF and PPSs at our hospital after 2016 and completed a 3-year postoperative follow-up. The rate and morphology of bone fusion and rod fracture rate in the thoracic and lumbosacral vertebrae were evaluated. Patients were divided into the thoracic spine spontaneous bone fusion group and the bone fusion failure group. The data of various spinopelvic parameters and the incidence of complications were compared. The vertebral body conditions in the thoracic spine were classified as less degenerative (type N), osteophyte (type O), and diffuse idiopathic skeletal hyperostosis (DISH) (type D). Results: After three postoperative years, the bone fusion rates were 54%, 95%, and 89% for the thoracic, lumbar, and lumbosacral spine, respectively. Screw loosening in the thoracic vertebrae was significantly higher in the bone fusion failure group, while no significant differences were observed in the spinopelvic parameters, Oswestry Disability Index (ODI), and rate of proximal junctional kyphosis and rod fractures. Type N vertebral body condition and screw loosening were identified as risk factors for spontaneous bone fusion failure in the thoracic spine. Conclusion: This study indicated that spontaneous bone fusion is likely to be obtained without screw loosening, and even if bone fusion is not obtained, there is no effect on clinical results with the mid-term (3-year) results of CMIS without bone grafting in the thoracic spine. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

15 pages, 4793 KiB

Open AccessArticle

A New Treatment Algorithm That Incorporates Minimally Invasive Surgery for Pyogenic Spondylodiscitis in the Thoracic and Lumbar Spines: The Results of Its Clinical Application to a Series of 34 Patients

by Yoichi Tani, Takanori Saito, Shinichiro Taniguchi, Masayuki Ishihara, Masaaki Paku, Takashi Adachi, Muneharu Ando and Yoshihisa Kotani

Medicina 2022, 58(4), 478; https://doi.org/10.3390/medicina58040478 - 25 Mar 2022

Cited by 7 | Viewed by 3427

Abstract

Background and Objectives: Spinal minimally invasive surgery (MIS) experts at the university hospital worked as a team to develop a new treatment algorithm for pyogenic spondylodiscitis in lumbar and thoracic spines. They modified a flow chart introduced for this condition in a pre-MIS [...] Read more.

Background and Objectives: Spinal minimally invasive surgery (MIS) experts at the university hospital worked as a team to develop a new treatment algorithm for pyogenic spondylodiscitis in lumbar and thoracic spines. They modified a flow chart introduced for this condition in a pre-MIS era to incorporate MIS techniques based on their extensive experiences accumulated over the years, both in MIS for degenerative lumbar diseases and in the treatment of spine infections. The MIS procedures incorporated in this algorithm consisted of percutaneous pedicle screw (PPS)–rod fixation and transpsoas lateral lumbar interbody fusion (LLIF). The current study analyzed a series of 34 patients treated with prospective selection of the methods according to this new algorithm. Materials and Methods: The algorithm first divided the patients into those who had escaped complicated disease conditions, such as neurologic impairment, extensive bone destruction, and the need to be mobilized without delay (Group 1) (19), and those with complicated pyogenic spondylodiscitis (Group 2) (15). Group 1 had image-guided needle biopsy followed by conservative treatment alone with antibiotics and a spinal brace (12) (Group 1-A) or a subsequent addition of non-fused PPS–rod fixation (7) (Group 1-B). Group 2 underwent an immediate single-stage MIS with non-fused PPS–rod fixation followed by posterior exposure for decompression and debridement through a small midline incision (12) (Group 2-A) or an additional LLIF procedure after an interval of 3 weeks (3) (Group 2-B). Results: All patients, except four, who either died from causes unrelated to the spondylodiscitis (2) or became lost to follow up (2), were cured of infection with normalized CRP at an average follow up of 606 days (105–1522 days). A solid interbody fusion occurred at the affected vertebrae in 15 patients (50%). Of the patients in Group 2, all but two regained a nearly normal function. Despite concerns about non-fused PPS–rod instrumentation, only seven patients (21%) required implant removal or replacement. Conclusions: Non-fused PPS–rod placements into infection-free vertebrae alone or in combination with posterior debridement through a small incision worked effectively in providing local stabilization without contamination of the metal implant from the infected tissue. MIS LLIF allowed for direct access to the infected focus for bone grafting in cases of extensive vertebral body destruction. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

8 pages, 628 KiB

Open AccessArticle

Association between the Horizontal Gaze Ability and Physical Characteristics of Patients with Dropped Head Syndrome

by Tatsuya Igawa, Ken Ishii, Ryunosuke Urata, Akifumi Suzuki, Hideto Ui, Kentaro Ideura, Norihiro Isogai, Yutaka Sasao and Haruki Funao

Medicina 2022, 58(4), 465; https://doi.org/10.3390/medicina58040465 - 23 Mar 2022

Cited by 1 | Viewed by 2160

Abstract

Background and Objectives: Patients with dropped head syndrome exhibit weakness of the cervical paraspinal muscles. However, the relationship between horizontal gaze disorder and physical function remains unclear. This study aimed to examine and clarify this relationship. Materials and Methods: Ninety-six patients with dropped [...] Read more.

Background and Objectives: Patients with dropped head syndrome exhibit weakness of the cervical paraspinal muscles. However, the relationship between horizontal gaze disorder and physical function remains unclear. This study aimed to examine and clarify this relationship. Materials and Methods: Ninety-six patients with dropped head syndrome were included. We measured the McGregor’s Slope and investigated physical characteristics, including cervical muscle strength, back muscle strength, and walking ability. Factor analysis was used to classify the characteristics of physical function, and a linear multiple regression analysis was used to evaluate independent variables explaining the variance in the McGregor’s Slope. The physical functions of DHS patients were classified into three categories by factor analysis: limb and trunk muscle strength, walking ability, and neck muscle strength. Results: The average value of the McGregor’s Slope was 22.2 ± 24.0 degrees. As a result of multiple regression analysis, walking speed (β = −0.46) and apex (β = −0.30) were extracted as significant factors influencing the McGregor’s Slope. Conclusions: Horizontal gaze disorders are not associated with cervical muscle strength but with the walking ability and the alignment type of dropped head syndrome. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

9 pages, 1179 KiB

Open AccessArticle

Platelet-Rich Plasma-Releasate (PRPr) for the Treatment of Discogenic Low Back Pain Patients: Long-Term Follow-Up Survey

by Koji Akeda, Norihiko Takegami, Junichi Yamada, Tatsuhiko Fujiwara, Kohshi Ohishi, Satoshi Tamaru and Akihiro Sudo

Medicina 2022, 58(3), 428; https://doi.org/10.3390/medicina58030428 - 16 Mar 2022

Cited by 10 | Viewed by 3849

Abstract

Background and Objectives: Clinical studies of platelet-rich plasma (PRP) for the treatment of low back pain (LBP) have been reported; however, less is known about its long-term efficiency. Materials and Methods: This study was a long-term follow-up of a previous prospective clinical feasibility [...] Read more.

Background and Objectives: Clinical studies of platelet-rich plasma (PRP) for the treatment of low back pain (LBP) have been reported; however, less is known about its long-term efficiency. Materials and Methods: This study was a long-term follow-up of a previous prospective clinical feasibility study for the use of PRP releasate (PRPr) to treat discogenic LBP patients. Among 14 patients, 11 patients were evaluated for a long-term survey. The efficacy was assessed by a visual analogue scale (VAS) for LBP intensity and the Roland-Morris Disability Questionnaire (RDQ) for LBP-related disability. Radiographic disc height was evaluated for seven patients. Results: Improvements in VAS and RDQ were sustained at an average of 5.9 years after the intradiscal injection of PRPr (p < 0.01 vs. baseline, respectively). Clinically meaningful improvements (more than 30% decrease from baseline) in VAS and RDQ were identified in 91% of patients at final survey. The radiographic measurement of disc height of PRPr-injected discs showed a mild decrease (13.8% decrease compared to baseline) during the average 5.9 years. Conclusions: The results of this study with a small number of patients suggest that the intradiscal injection of PRPr has a safe and efficacious effect on LBP improvement for more than 5 years after treatment. Further large-scale studies would be needed to confirm the clinical evidence for the use of PRPr for the treatment of patients with discogenic LBP. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

10 pages, 3552 KiB

Open AccessArticle

Comparison of Navigated Expandable Vertebral Cage with Conventional Expandable Vertebral Cage for Minimally Invasive Lumbar/Thoracolumbar Corpectomy

by Masato Tanaka, Mahendra Singh, Yoshihiro Fujiwara, Koji Uotani, Yoshiaki Oda, Shinya Arataki, Taro Yamauchi, Tomoyuki Takigawa and Yasuo Ito

Medicina 2022, 58(3), 364; https://doi.org/10.3390/medicina58030364 - 1 Mar 2022

Cited by 7 | Viewed by 3113

Abstract

Background and Objectives: The thoracolumbar burst fracture is one of the most common spinal injuries. If the patient has severe symptoms, corpectomy is indicated. Currently, minimally invasive corpectomy with a navigated expandable vertebral cage is available thanks to spinal surgical technology. The [...] Read more.

Background and Objectives: The thoracolumbar burst fracture is one of the most common spinal injuries. If the patient has severe symptoms, corpectomy is indicated. Currently, minimally invasive corpectomy with a navigated expandable vertebral cage is available thanks to spinal surgical technology. The aim of this study is to retrospectively compare clinical and radiographic outcomes of conventional and navigational minimally invasive corpectomy techniques. Materials and Methods: We retrospectively evaluated 21 patients who underwent thoracolumbar minimally invasive corpectomy between October 2016 and January 2021. Eleven patients had a navigated expandable cage (group N) and 10 patients had a conventional expandable cage (group C). Mean follow-up period was 31.9 months for group N and 34.7 months for group C, ranging from 12 to 42 months in both groups. Clinical and radiographic outcomes are assessed using values including visual analogue scale (VAS) for back pain and Oswestry disability index (ODI). This data was collected preoperatively and at 6, 12, and 24 months postoperatively. Results: Surgical time and intraoperative blood loss of both groups were not significantly different (234 min vs. 267 min, 656 mL vs. 786 mL). Changes in VAS and ODI were similar in both groups. However, lateral cage mal-position ratio in group N was lower than that of group C (relative risk 1.64, Odds ratio 4.5) and postoperative cage sinking was significantly lower in group N (p = 0.033). Conclusions: Clinical outcomes are not significantly different, but radiographic outcomes of lateral cage mal-position and postoperative cage sinking were significantly lower in the navigation group. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

11 pages, 4053 KiB

Open AccessFeature PaperArticle

Effect of Minimally Invasive Spine Stabilization in Metastatic Spinal Tumors

by Kazuo Nakanishi, Kazuya Uchino, Seiya Watanabe, Kosuke Misaki and Hideaki Iba

Medicina 2022, 58(3), 358; https://doi.org/10.3390/medicina58030358 - 1 Mar 2022

Cited by 5 | Viewed by 2890

Abstract

Background and Objectives: There have been numerous advances in spine surgery for metastatic spinal tumors, and minimally invasive spine stabilization (MISt) is becoming increasingly popular in Japan. MISt is a minimally invasive fixation procedure that temporarily stabilizes the spine, thereby reducing pain, [...] Read more.

Background and Objectives: There have been numerous advances in spine surgery for metastatic spinal tumors, and minimally invasive spine stabilization (MISt) is becoming increasingly popular in Japan. MISt is a minimally invasive fixation procedure that temporarily stabilizes the spine, thereby reducing pain, preventing pathological fractures, and improving activities of daily living at an early stage. MISt may be useful given the recent shift toward outpatient cancer treatment. Materials and Methods: This study enrolled 51 patients with metastatic spinal tumors who underwent surgery using MISt between December 2013 and October 2020. The Spinal Instability Neoplastic Score, an assessment of spinal instability, was used to determine the indication for surgery, and the Epidural Spinal Cord Compression scale was used for additional decompression. Results: The patients comprised 34 men and 17 women, and the mean age at surgery was 68.9 years. The mean postoperative follow-up period was 20.8 months, and 35 of 51 patients (67%) had died by the last survey. The mean operative time was 159.8 min, mean blood loss was 115.7 mL, and mean time to ambulation was 3.2 days. No perioperative complications were observed, although two patients required refixation surgery. Preoperatively, 37 patients (72.5%) were classified as Frankel grade E. There were no cases of postoperative exacerbation, and six patients showed improvement of one or more Frankel grades after surgery. The median duration of patient survival was about 22.0 months. Patients with breast, prostate, renal, and thyroid cancers had a good prognosis, whereas those with gastrointestinal and head and neck cancers had a poor prognosis. Conclusions: MISt can benefit patients who are ineligible for conventional, highly invasive surgery and is also suitable because cancer treatment is increasingly performed on an outpatient basis. Furthermore, choosing the right surgery for the right patient at the right time can significantly affect life expectancy. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

9 pages, 1707 KiB

Open AccessArticle

Efficacy of Minimally Invasive Trans-Sacral Canal Plasty between Patients with and without Failed Back Surgery Syndrome

by Haruki Funao, Kimiaki Yokosuka, Junichi Ukai, Kazuo Nakanishi, Masaaki Paku, Takashi Tomita, Masahiro Hoshino, Takanori Saito, Ken Ishii and Koji Sato

Medicina 2022, 58(2), 251; https://doi.org/10.3390/medicina58020251 - 7 Feb 2022

Cited by 4 | Viewed by 2762

Abstract

Background and Objectives: Clinicians are required to manage a growing number of elderly patients with several medical comorbidities, and invasive surgical treatments are sometimes not advisable for these patients. The aim of this study was to evaluate the efficacy of minimally invasive intraspinal [...] Read more.

Background and Objectives: Clinicians are required to manage a growing number of elderly patients with several medical comorbidities, and invasive surgical treatments are sometimes not advisable for these patients. The aim of this study was to evaluate the efficacy of minimally invasive intraspinal canal treatment, trans-sacral canal plasty (TSCP), for patients with and without failed back surgery syndrome (FBSS). Materials and Methods: A multicenter analysis was conducted. TSCP was performed in patients with chronic low back pain and leg pain due to lumbar spinal disorders. An adhesiolysis by TSCP was carried out, then a mixture of steroid and local anesthesia was injected. Visual Analog Scales (VAS) for low back pain and leg pain, and complications were evaluated. Results: A total of 271 patients with a minimum 6-month follow-up were enrolled. There were 80 patients who had a history of previous lumbar spinal surgery (F group), and 191 patients without previous lumbar spinal surgery (N group). There were no significant differences in sex and age between the two groups. VAS scores for low back pain (N group/F group) preoperatively, immediately postoperatively, and 1 month, 3 months and 6 months postoperatively, were 51/52 mm, 24/26 mm, 33/34 mm, 30/36 mm, and 30/36 mm, respectively. VAS scores for leg pain were 69/67 mm, 28/27 mm, 39/41 mm, 36/43 mm, and 32/40 mm, respectively. Both VAS scores for low back pain and leg pain were significantly decreased from baseline to final follow-up in both groups (p < 0.01). However, VAS scores for leg pain at 3 months and 6 months postoperatively were significantly higher in F group (p < 0.05). There were three catheter breakages (2/3 in F group), and one dural tear in F group. Conclusions: TSCP significantly reduced both VAS scores for low back and leg pain in patients with and without FBSS. However, co-existence of intractable epidural adhesion might be associated with less improvement in FBSS. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

8 pages, 1044 KiB

Open AccessArticle

Respective Correction Rates of Lateral Lumbar Interbody Fusion and Percutaneous Pedicle Screw Fixation for Lumbar Degenerative Spondylolisthesis

by Norihiro Isogai, Kodai Yoshida, Yuta Shiono, Yutaka Sasao, Haruki Funao and Ken Ishii

Medicina 2022, 58(2), 169; https://doi.org/10.3390/medicina58020169 - 23 Jan 2022

Cited by 2 | Viewed by 3351

Abstract

Background and Objectives: There are few reports describing the radiographic correction of vertebral slippage in lateral interbody fusion and percutaneous pedicle screw fixation for lumbar degenerative spondylolisthesis. [Objectives] We evaluated the intraoperative surgical correction obtained by lateral interbody fusion and percutaneous pedicle screw [...] Read more.

Background and Objectives: There are few reports describing the radiographic correction of vertebral slippage in lateral interbody fusion and percutaneous pedicle screw fixation for lumbar degenerative spondylolisthesis. [Objectives] We evaluated the intraoperative surgical correction obtained by lateral interbody fusion and percutaneous pedicle screw procedures. Materials and Methods: Fifty patients were included in this study. According to the Meyerding classification, 35 cases were Grade 1 and 15 cases were Grade 2. Mean age was 64.7 ± 6.4 years old. Seventeen cases were male, and 33 cases were female. The mean preoperative % slip was 21.1 ± 7.0%. After lateral interbody fusion, vertebral slippage was corrected using reduction technique by percutaneous pedicle screw. Results: The slippage of vertebra was reduced to 11.5 ± 6.5% after lateral interbody fusion procedure and 4.0 ± 6.0% after percutaneous pedicle screw procedure. One year after surgery, the slippage of vertebra was 4.1 ± 6.6%. The correction rate of lateral interbody fusion was 47.7 ± 25.1%, and that of percutaneous pedicle screw was 33.8 ± 2.6%. The total correction rate was 81.5 ± 27.7%. There was no significant loss of correction one year after surgery. The Japanese Orthopaedic Association Score significantly improved from 14.7 ± 4.2 to 27.7 ± 1.7 points at final follow up. No vascular or organ injury was observed during surgery, and there were no postoperative surgical site infections or systemic complications. Conclusion: Compared with previous reports, the final correction rate and the correction rate of the percutaneous pedicle screw procedure were particularly high in this study. Lateral interbody fusion and percutaneous pedicle screw using reduction technique provide excellent clinical and radiographic outcomes for patients with lumbar degenerative spondylolisthesis. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

Review

Jump to: Research, Other

13 pages, 5758 KiB

Open AccessReview

Minimally Invasive Spinal Treatment (MIST)—A New Concept in the Treatment of Spinal Diseases: A Narrative Review

by Ken Ishii, Goichi Watanabe, Takashi Tomita, Takuya Nikaido, Tomohiro Hikata, Akira Shinohara, Masato Nakano, Takanori Saito, Kazuo Nakanishi, Tadatsugu Morimoto, Norihiro Isogai, Haruki Funao, Masato Tanaka, Yoshihisa Kotani, Takeshi Arizono, Masahiro Hoshino and Koji Sato

Medicina 2022, 58(8), 1123; https://doi.org/10.3390/medicina58081123 - 18 Aug 2022

Cited by 6 | Viewed by 3691

Abstract

In the past two decades, minimally invasive spine surgery (MISS) techniques have been developed for spinal surgery. Historically, minimizing invasiveness in decompression surgery was initially reported as a MISS technique. In recent years, MISS techniques have also been applied for spinal stabilization techniques, [...] Read more.

In the past two decades, minimally invasive spine surgery (MISS) techniques have been developed for spinal surgery. Historically, minimizing invasiveness in decompression surgery was initially reported as a MISS technique. In recent years, MISS techniques have also been applied for spinal stabilization techniques, which were defined as minimally invasive spine stabilization (MISt), including percutaneous pedicle screws (PPS) fixation, lateral lumbar interbody fusion, balloon kyphoplasty, percutaneous vertebroplasty, cortical bone trajectory, and cervical total disc replacement. These MISS techniques typically provide many advantages such as preservation of paraspinal musculature, less blood loss, a shorter operative time, less postoperative pain, and a lower infection rate as well as being more cost-effective compared to traditional open techniques. However, even MISS techniques are associated with several limitations including technical difficulty, training opportunities, surgical cost, equipment cost, and radiation exposure. These downsides of surgical treatments make conservative treatments more feasible option. In the future, medicine must become “minimally invasive” in the broadest sense—for all patients, conventional surgeries, medical personnel, hospital management, nursing care, and the medical economy. As a new framework for the treatment of spinal diseases, the concept of minimally invasive spinal treatment (MIST) has been proposed. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

10 pages, 3304 KiB

Open AccessReview

The History and Development of the Percutaneous Pedicle Screw (PPS) System

by Ken Ishii, Haruki Funao, Norihiro Isogai, Takanori Saito, Takeshi Arizono, Masahiro Hoshino and Koji Sato

Medicina 2022, 58(8), 1064; https://doi.org/10.3390/medicina58081064 - 7 Aug 2022

Cited by 8 | Viewed by 4594

Abstract

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using the SEXTANT^® system (Medtronic) featured the first generation of commercially available percutaneous pedicle screw (PPS) system in 2001. The innovative system has since become standard instrumentation used worldwide, and PPS is now used for [...] Read more.

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using the SEXTANT^® system (Medtronic) featured the first generation of commercially available percutaneous pedicle screw (PPS) system in 2001. The innovative system has since become standard instrumentation used worldwide, and PPS is now used for long-segment minimally invasive surgery (MIS) spinal fixation from the thoracic spine to the pelvis for pathological conditions. PPS systems have been developed for approximately 20 years for the purpose of improving minimally invasive techniques, safety of instrumentation, and ease of use. The third-generation PPS systems established the insertion technique, and the development of the fourth-generation PPS systems have made great strides in minimizing the number of steps in the operative procedure. In the future, PPS systems are expected to continue making use of the latest technological advancements and to develop further with the aim of ensuring greater safety, reducing operator stress, and preventing complications such as insertion errors and infection. In this review article, we describe the historical evolution from the first-generation PPS system to the current PPS systems used today. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

9 pages, 2996 KiB

Open AccessReview

Reinforcement of Percutaneous Pedicle Screw Fixation with Hydroxyapatite Granules in Patients with Osteoporotic Spine: Biomechanical Performance and Clinical Outcomes

by Haruo Kanno, Yoshito Onoda, Ko Hashimoto, Toshimi Aizawa and Hiroshi Ozawa

Medicina 2022, 58(5), 579; https://doi.org/10.3390/medicina58050579 - 23 Apr 2022

Cited by 4 | Viewed by 3281

Abstract

In percutaneous pedicle screw (PPS) fixation of the osteoporotic spine, rigid screw fixation obtaining strong stabilization is important for achieving successful treatment outcomes. However, in patients with severe osteoporosis, it is difficult to obtain PPS fixation with sufficient stability. PPS fixation has potential [...] Read more.

In percutaneous pedicle screw (PPS) fixation of the osteoporotic spine, rigid screw fixation obtaining strong stabilization is important for achieving successful treatment outcomes. However, in patients with severe osteoporosis, it is difficult to obtain PPS fixation with sufficient stability. PPS fixation has potential disadvantages with respect to maintaining secure stabilization in comparison to conventional pedicle screw fixation. In PPS fixation, bone grafting to achieve posterior spine fusion is generally not applicable and transverse connectors between the rods cannot be used to reinforce the fixation. Various augmentation methods, including additional hooks, sublaminar bands, and hydroxyapatite (HA) sticks, are available for conventional pedicle screw fixation. On the other hand, there has been no established augmentation method for PPS fixation. Recently, we developed a novel augmentation technique for PPS fixation using HA granules. This technique allows the percutaneous insertion of HA granules into the screw hole along the guidewire prior to insertion of the PPS. We have used this augmentation technique for PPS fixation in various spine surgeries in patients with osteoporosis. In our previous studies, biomechanical analyses demonstrated that PPS fixation was significantly enhanced by augmentation with HA granules in the osteoporotic lumbar spine. Furthermore, augmentation with HA granules was considered to decrease the incidence of screw loosening and implant failure following PPS fixation in patients with osteoporotic spine. In this article, we describe the surgical procedures of the augmentation method using HA granules and summarize our data from the biomechanical analysis of augmentation for PPS fixation. We also review the surgical outcomes of PPS fixation with augmentation using HA granules. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

17 pages, 3182 KiB

Open AccessReview

Microendoscopic Lumbar Posterior Decompression Surgery for Lumbar Spinal Stenosis: Literature Review

by Akinobu Suzuki and Hiroaki Nakamura

Medicina 2022, 58(3), 384; https://doi.org/10.3390/medicina58030384 - 4 Mar 2022

Cited by 17 | Viewed by 7959

Abstract

Lumbar spinal stenosis (LSS) is a common disease in the elderly, mostly due to degenerative changes in the lumbar spinal complex. Decompression surgery is the standard surgical treatment for LSS. Classically, total laminectomy—which involves resection of the spinous process, entire laminae and medial [...] Read more.

Lumbar spinal stenosis (LSS) is a common disease in the elderly, mostly due to degenerative changes in the lumbar spinal complex. Decompression surgery is the standard surgical treatment for LSS. Classically, total laminectomy—which involves resection of the spinous process, entire laminae and medial facet—has been the standard decompression technique; however, it can cause post-surgical instability. To overcome this disadvantage, various minimally invasive techniques that preserve the stabilization structures of the spine have been developed, and surgeons have begun to re-evaluate decompression surgery from the standpoint of reduced invasiveness and cost. More than two decades have passed since the introduction of microendoscopic spine surgery, and studies continue to shed light on its advantages and limitations as new knowledge becomes available. This article is a narrative review of the available literature, along with authors’ experience, regarding the indications, surgical techniques, clinical outcomes, and limitations/complications of microendoscopic decompression for LSS. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

Other

Jump to: Research, Review

9 pages, 3045 KiB

Open AccessPerspective

Digital Transformation Will Change Medical Education and Rehabilitation in Spine Surgery

by Tadatsugu Morimoto, Hirohito Hirata, Masaya Ueno, Norio Fukumori, Tatsuya Sakai, Maki Sugimoto, Takaomi Kobayashi, Masatsugu Tsukamoto, Tomohito Yoshihara, Yu Toda, Yasutomo Oda, Koji Otani and Masaaki Mawatari

Medicina 2022, 58(4), 508; https://doi.org/10.3390/medicina58040508 - 2 Apr 2022

Cited by 14 | Viewed by 4589

Abstract

The concept of minimally invasive spine therapy (MIST) has been proposed as a treatment strategy to reduce the need for overall patient care, including not only minimally invasive spine surgery (MISS) but also conservative treatment and rehabilitation. To maximize the effectiveness of patient [...] Read more.

The concept of minimally invasive spine therapy (MIST) has been proposed as a treatment strategy to reduce the need for overall patient care, including not only minimally invasive spine surgery (MISS) but also conservative treatment and rehabilitation. To maximize the effectiveness of patient care in spine surgery, the educational needs of medical students, residents, and patient rehabilitation can be enhanced by digital transformation (DX), including virtual reality (VR), augmented reality (AR), mixed reality (MR), and extended reality (XR), three-dimensional (3D) medical images and holograms; wearable sensors, high-performance video cameras, fifth-generation wireless system (5G) and wireless fidelity (Wi-Fi), artificial intelligence, and head-mounted displays (HMDs). Furthermore, to comply with the guidelines for social distancing due to the unexpected COVID-19 pandemic, the use of DX to maintain healthcare and education is becoming more innovative than ever before. In medical education, with the evolution of science and technology, it has become mandatory to provide a highly interactive educational environment and experience using DX technology for residents and medical students, known as digital natives. This study describes an approach to pre- and intraoperative medical education and postoperative rehabilitation using DX in the field of spine surgery that was implemented during the COVID-19 pandemic and will be utilized thereafter. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

11 pages, 435 KiB

Open AccessSystematic Review

Usefulness of Lateral Lumbar Interbody Fusion Combined with Indirect Decompression for Degenerative Lumbar Spondylolisthesis: A Systematic Review

by Takuya Nikaido and Shin-ichi Konno

Medicina 2022, 58(4), 492; https://doi.org/10.3390/medicina58040492 - 29 Mar 2022

Cited by 8 | Viewed by 4870

Abstract

Background and Objective: The aim of this review was to analyze the existing literature and investigate the outcomes or complications of lateral lumbar interbody fusion (LLIF) combined with indirect decompression for degenerative lumbar spondylolisthesis (DS). Materials and Methods: A database search algorithm was [...] Read more.

Background and Objective: The aim of this review was to analyze the existing literature and investigate the outcomes or complications of lateral lumbar interbody fusion (LLIF) combined with indirect decompression for degenerative lumbar spondylolisthesis (DS). Materials and Methods: A database search algorithm was used to query MEDLINE, COCHRANE, and EMBASE to identify the literature reporting LLIF with indirect decompression for DS between January 2010 and December 2021. Improvements in outcome measures and complication rates were pooled and tested for significance. Results: A total of 412 publications were assessed, and 12 studies satisfied the inclusion criteria after full review. The pooled data available in the included studies showed that 438 patients with lumbar spondylolisthesis (mean age 65.2 years; mean body mass index (BMI) 38.1 kg/m²) underwent LLIF. A total of 546 disc spaces were operated on. The most frequently treated levels were L4–L5 and L3–L4. Clinically, the average improvement was 32.5% in ODI, 46.3 mm in low back pain, and 48.3 mm in leg pain estimated from the studies included. SF-36 PCS improved by 51.5% and MCS improved by 19.5%. For radiological outcomes, a reduction in slippage was seen in 6.3%. Disc height increased by 55%, foraminal height increased by 21.1%, the foraminal area on the approach side increased by 21.9%, and on the opposite side it increased by 26.1%. The cross-sectional spinal canal area increased by 20.6% after surgery. Post-operative complications occurred in 5–40% of patients with thigh symptoms, such as anterior thigh numbness, dysesthesia, discomfort, pain, and sensory deficits. Conclusions: Indirect decompression by LLIF for DS is an effective method for improving pain and dysfunction with less surgical invasion. In addition, it has the effect of significantly improving disc height, foraminal height and area, and segmental lordosis on radiological outcomes compared to the posterior approach. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

9 pages, 1266 KiB

Open AccessCase Report

The Short and Intensive Rehabilitation (SHAiR) Program Improves Dropped Head Syndrome Caused by Amyotrophic Lateral Sclerosis: A Case Report

by Ryunosuke Urata, Tatsuya Igawa, Akifumi Suzuki, Yutaka Sasao, Norihiro Isogai, Haruki Funao and Ken Ishii

Medicina 2022, 58(3), 452; https://doi.org/10.3390/medicina58030452 - 21 Mar 2022

Cited by 2 | Viewed by 4072

Abstract

Background and Objectives: Dropped head syndrome (DHS) is a syndrome that presents with correctable cervical kyphotic deformity as a result of weakening cervical paraspinal muscles. DHS with amyotrophic lateral sclerosis (ALS) is a relatively rare condition, and there is no established treatment. This [...] Read more.

Background and Objectives: Dropped head syndrome (DHS) is a syndrome that presents with correctable cervical kyphotic deformity as a result of weakening cervical paraspinal muscles. DHS with amyotrophic lateral sclerosis (ALS) is a relatively rare condition, and there is no established treatment. This is the first case report describing the improvement of both dropped head (DH) and cervical pain after the short and intensive rehabilitation (SHAiR) program in an ALS patient with DHS. Case Report: After being diagnosed with ALS in June 2020, a 75-year-old man visited our hospital in October 2020 to receive treatment for DHS. At the initial visit, the patient’s DH was prominent during standing and walking. The pain intensity of the neck was 9 out of 10 on the numerical rating scale (NRS), which was indicative of severe pain. The patient was hospitalized for 2 weeks and admitted into the SHAiR program. DH began to decrease one week after undergoing the SHAiR program and improved two weeks later. Neck pain decreased from 9 to 6 on the NRS. Results: The SHAiR program is a rehabilitation program aimed at improving DH in patients with idiopathic DHS. The program was designed to improve neck extensor and flexor function and global spinal alignment, and the program may have contributed to the improvement of DH and neck pain. Currently, reports of conservative therapies for this disease are limited to the use of cervical orthosis. Although further research is needed on the safety and indications of treatment, the SHAiR program may be a viable treatment option. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Minimally Invasive Spinal Treatment (MIST)—a New Concept in the Treatment of Spinal Diseases

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (20 papers)

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI