Complication management with minimally invasive spine procedures

Acta Medica Philippina

Background. Minimally invasive spine surgical techniques (MISST) are associated with less intraoperative blood loss, shorter duration of surgery, and less post-operative pain. In the last two decades, MISST have been performed on an outpatient basis in developed countries but it is still performed primarily on an inpatient basis in the Philippines. This study aims to determine the safety and effectiveness of performing MISST in an ambulatory surgical center in the Philippines. Methods. A retrospective chart review of patients who underwent MISST in an ambulatory surgical center (ASC) in Manila, Philippines, from January 2014 to December 2018 was done. The different types of MISST were identified and analyzed as to patient demographic characteristics, anesthetic perioperative management, outcomes and complications. Results. Out of 337 patients included in the review, 8 types of MISST were identified. The average patient age was 55.61 years. Majority (98.2%) of the patients were class...

The Open Orthopaedics Journal, 2015

Purpose: Complications are the chief concern of patients and physicians when considering spine surgery. The authors seek to assess the incidence of complications in patients undergoing spine surgery and identify risk factors for their occurrence.

2020

Introduction :In the past half of century, the spinal surgery techniques has advanced significantly. Along with the improvement and various of techniques and technologies in general, there has been a big movement to reduce the morbidity of surgery. Case review : As opposed to open spine surgery, minimally invasive surgical approaches can be faster, safer and require less recovery time. The minimally invasive spine surgery also need to make an efficient target of surgery. The roots in minimally invasive spine surgery (MISS) are based primarily on technique modifications. Discussion: The Williams microdiscectomy, described in 1978, revolutionized MISS by starting the evolution of lumbar discectomy from an open surgery through a 6-inch incision to a microsurgical approach through as small an opening as possible. Conclusion :We don’t use the MISS technique when the extension of tumor is more than 2 levels; extension of the tumor is 20% longer than diameter of largest retractor; the tumo...

SAS Journal, 2011

Background: The goal of this editorial and literature review is to define the term "minimally invasive surgery" (MIS) as it relates to the spine and characterize methods of measuring parameters of a spine MIS technique. Methods: This report is an analysis of 105,845 cases of spinal surgery in unmatched series and 95,161 cases in paired series of open compared with MIS procedures performed by the same surgeons to develop quantitative criteria to analyze the success of MIS. Results: A lower rate of deep infection proved to be a key differentiator of spinal MIS. In unmatched series the infection rate for 105,845 open traditional procedures ranged from 2.9% to 4.3%, whereas for MIS, the incidence of infection ranged from 0% to 0.22%. For matched paired series with the open and MIS procedures performed by the same surgeons, the rate of infection in open procedures ranged from 1.5% to 10%, but for spine MIS, the rate of deep infection was much lower, at 0% to 0.2%. The published ranges for open versus MIS infection rates do not overlap or even intersect, which is a clear indication of the superiority of MIS for one specific clinical outcome measure (MIS proves superior to open spine procedures in terms of lower infection rate). Conclusions: It is difficult, if not impossible, to validate that an operative procedure is "less invasive" or "more minimally invasive" than traditional surgical procedures unless one can establish a commonly accepted definition of MIS. Once a consensus definition or precise definition of MIS is agreed upon, the comparison shows a higher infection rate with traditional spinal exposures versus MIS spine procedures.

Spine, 2016

Spine 2016;41:S39-S43 M inimally invasive spine (MIS) surgery has rapidly evolved over the past decade and is increasingly being applied in the treatment of complex spinal pathologies. This journal last published a focus issue on MIS surgery in late 2010 and, in that issue, set forth the following, ''We propose a definition [of MIS surgery] based on identifying the common goals and principles of MIS surgery-'An MIS procedure is one that by virtue of the extent and means of surgical technique results in less collateral tissue damage, results in [a] measureable decrease in morbidity and more rapid functional recovery than traditional exposures, without differentiation in the intended surgical goal.''' 1 At the time of the last focus issue, MIS surgery could well be described as having been in its adolescence, as was reflected in the table of contents that was dedicated primarily to describing foundational

Current Opinion in Orthopaedics, 2006

Purpose of review Minimally invasive spine surgery is a rapidly growing field of significant interest to both surgeons and patients. Recent advances in surgical technology and technique now enable the spinal surgeon to access the spine whilst preserving the surrounding soft tissues; thereby decreasing postoperative pain. Recent findings In recent years, a variety of technological advances in microscopy, tissue retractors and specialized instruments have become available which make small incision spinal surgery possible. Currently, a variety of spinal pathologies including herniated discs, spinal stenosis and some forms of spinal instability can be successfully treated with a minimally invasive spine surgery approach. Although small incision spinal surgery has a definable learning curve, most patients requiring a lumbar decompression for a localized spinal pathology would be potential candidates for this approach. Certain new skills must be mastered by the spinal surgeon to allow safe and efficient surgery to be performed with the minimally invasive approach. Summary Minimally invasive spine surgery is a promising area of surgery with the potential to significantly decrease the perioperative morbidity to patients requiring spinal surgery. Surgical skills to perform these procedures can be gained through instruction. In the future, well designed clinical outcome studies are needed to define the benefits of minimally invasive spine surgery in comparison with the traditional surgical approaches.

Spine, 2010

Study Design. Systematic review. Objective. To define the term "complications" from the spine surgery literature and contrast this with definitions from other federal institutions, to summarize the incidence of adverse events in cervical, thoracic, and lumbar spine surgery, to include the factors that contribute to these events, and to determine the relationship between complications and patient centered outcomes. Summary of Background Data. Efforts to understand and reduce complications in medicine, and spine surgery in particular have been hampered as a result of the lack of a meaningful and universally acceptable definition. The complex field of spine surgery has been a particularly challenging area for the development of a consensus to constructively describe these "undesirable/unanticipated developments arising during or out of the delivery of health care." Furthermore, an overall understanding of expected complication rates after major spine surgery is lacking. Methods. A systematic review of the English literature was undertaken for articles published between 1990 and December 2008. Electronic and federal databases and reference lists of key articles were searched to identify articles defining complications and reporting rates of spine surgical complications. Two independent reviewers assessed the level of evidence quality using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria and disagreements were resolved by consensus. Results. The definitions for complications in the spine literature and federal agencies are inconsistent and at times conflicting. Mortality rates for cervical spine and lumbar spine surgery are Ͻ1%. For thoracic spine surgery, rates range from 0.3% to 7%. Complication rates range from 5% to 19%, 7% to 18%, and 4% to 14% after cervical, thoracic, and lumbar spine surgery, respectively. Findings from a single study indicate that major compli-cations may have an impact on 1-year self-perceived general health. However, minor complications may not. Conclusion. We define a complication as an unintended and undesirable diagnostic or therapeutic event that may impact the patient's care. Complications should be recorded and analyzed relative to disease severity, patient comorbidities, and ultimately their effect on patient outcomes. Further work needs to be done to develop a complication risk impact index that has the ability to help us assess and communicate the interaction of patient cormobidities and complication severity on patient centered outcomes.

Neurosurgical Focus, 2008

Minimally invasive surgery (MIS) in the spine was primarily developed to reduce approach-related morbidity and to improve clinical outcomes compared with those following conventional open spine surgery. Over the past several years, minimally invasive spinal procedures have gained recognition and their utilization has increased. In particular, MIS is now routinely used in the treatment of degenerative spine disorders and has been shown to be as effective as conventional open spine surgeries. Although the procedures are not yet widely recognized in the context of complex spine surgery, the true potential in minimizing approach-related morbidity is far greater in the treatment of complex spinal diseases such as spinal trauma, spinal deformities, and spinal oncology. Conventional open spine surgeries for complex spinal disorders are often associated with significant soft tissue disruption, blood loss, prolonged recovery time, and postsurgical pain. In this article the authors review num...

World Neurosurgery, 2018

Innovative techniques have revolutionized minimally invasive surgeries, which has significant benefits for the patients. Despite the benefits, these advancements require a longer learning curve for an inexperienced surgeon. The authors have collected some pearls from their experience and from other surgeons. Tips and tricks about common MISS procedures such as minimally invasive endoscopic transforaminal lumbar disc and interlaminar discectomy, MIS, TLIF, LLIF, ALIF, spinal tumor excision, posterior cervical fixation and foraminotomy are described. How to stay out of trouble is explained with these surgeries. These techniques will help young surgeons to become proficient and achieve better outcome.

SAS Journal, 2008

Interest in minimally invasive surgery (MIS) of the spine has driven the development of new and innovative techniques to treat an ever wider range of spinal disorders. Despite these new advances, spine surgeons have been slow in adopting MIS into their clinical practice. This study aims to provide a better understanding of the factors that have led to limited incorporation of these procedures into their practices.