Minim Invasive Neurosurg 2011; 54(2): 100-103
DOI: 10.1055/s-0031-1275353
Technical Note

© Georg Thieme Verlag KG Stuttgart · New York

Long Constructs in the Thoracic and Lumbar Spine with a Minimally Invasive Technique

H. Roldan1 , L. Perez-Orribo1 , M. Spreafico1 , M. Ginoves-Sierra1
  • 1Neurosurgery Department, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
Further Information

Publication History

Publication Date:
07 June 2011 (online)

Abstract

Background: Literature about long implants used together with a minimally invasive spine surgery (MISS) technique is scarce. Our objective is to contribute our surgical experience in this field and to specifically focus on several technical details.

Patients and Methods: A digitally-dissected canal along the paravertebral muscles was created linking the stab wounds on each side in relation with the pedicles to be cannulated. Screws were inserted following the percutaneous technique. Long rods were modelled, threaded through the extender sleeves along the paravertebral canal and pushed into the screw heads with the reduction forceps. When fusion was needed, the facet complex was decorticated with a drill. To insert a cross-link, a canal between the 2 rods was digitally created and the spinous process was drilled.

Results: 8 patients underwent surgery (age range: 25–77 years). Indications were postosteomyelitis kyphosis in 3 patients, bone tumor in 3, and spine fracture in 2. No blood transfusions were necessary during or after surgery. A cross-link was inserted in 2 patients. Posterolateral bone fusion was attempted in 4, but radiologically identifiable in none. In one patient a cantilever manoeuvre was done to correct kyphosis. Mean duration of surgery was 4 h. There were no clinical complications related to the operation or the hardware (mean follow-up of 7.14 months, range: 1–15 months).

Conclusion: The application of MISS techniques can be broadened to long spinal constructs to assess fractures, tumors or deformity, especially in elderly or debilitated patients. Nevertheless, posterolateral fusion is still a challenge through these limited exposures.

References

  • 1 Hsieh PC, Koski TR, Sciubba DM. et al . Maximizing the potential of minimally invasive spine surgery in complex spinal disorders.  Neurosurg Focus. 2008;  25 E19
  • 2 Logroscino CA, Proietti L, Tamburrelli FC. Minimally invasive spine stabilisation with long implants.  Eur Spine J. 2009;  18 (S 01) 75-81
  • 3 Anand N, Baron EM, Thaiyananthan G. et al . Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis: a technique and feasibility study.  J Spinal Disord Tech. 2008;  21 459-467
  • 4 Wang MY, Anderson DG, Poelstra KA. et al . Minimally invasive posterior fixation.  Neurosurgery. 2008;  63 A197-A203
  • 5 Foley KT, Gupta SK, Justis JR. et al . Percutaneous pedicle screw fixation of the lumbar spine.  Neurosurg Focus. 2001;  10 E10
  • 6 Khoo LT, Palmer S, Laich DT. et al . Minimally invasive percutaneous posterior lumbar interbody fusion.  Neurosurgery. 2002;  51 S166-S171
  • 7 Harris EB, Massey P, Lawrence J. et al . Percutaneous techniques for minimally invasive posterior lumbar fusion.  Neurosurg Focus. 2008;  25 E12
  • 8 Valdevit A, Kambic HE, McLain RF. Torsional stability of cross-link configurations: a biomechanical analysis.  Spine J. 2005;  5 441-445
  • 9 Brodke DS, Bachus KN, Mohr RA. et al . Segmental pedicle screw fixation or cross-links in multilevel lumbar constructs: a biomechanical analysis.  Spine J. 2001;  1 373-379
  • 10 McCafferty RR, Khoo LT, Perez-Cruet MJ. Percutaneous pedicle screw fixation of the lumbar spine using the Pathfinder system.. In: Perez-Cruet MJ, Khoo LT, Fessler RG, eds. An anatomical approach to minimally invasive spine surgery Quality Medical Publishing, Inc., St. Louis, Missouri; 2006: 599-614

Correspondence

H. Roldan

Neurosurgery Department

Hospital Universitario de

Canarias

Ofra s/n.

La Cuesta

La Laguna

38320 Santa Cruz de Tenerife

Spain

Phone: +34/922/678 900

Fax: +34/922/319 425

Email: hecroldan@gmail.com