Core Techniques of Minimally Invasive Spine Surgery

Preface
Preface
Preface
Contents
Part I: Introduction
History of Minimally Invasive Spine Surgery
1 Introduction
2 The Beginning of MISS
3 Endoscopic Spine Surgery (ESS)
4 MIS Decompression and Fusion
5 Intradiscal Therapy
6 Other Percutaneous Treatment
7 Summary
References
Basic Concepts and Nomenclature of Minimal Invasive Spine Surgery
1 Introduction
2 Main Text
3 Summary
References
Learning Curve and Complications of Minimally Invasive Spine Surgery
1 Introduction
2 The Basic Concept of the Minimally Invasive Spine Surgery
3 Learning Curve of Minimally Invasive Spine Surgery
3.1 What Is the Learning Curve?
3.2 Cut-Off Point of the Learning Curve
3.3 Outcome Measures: Task-Efficiency Measures vs. Patient Outcome Measures
3.4 Current Learning Curve Studies of Minimally Invasive Spine Surgery
4 Typical Complications Related to Minimally Invasive Spine Surgery
4.1 How to Speed Up the Learning Curve and Prevent Complications
5 Summary
References
Part II: Endoscopic Spine Surgery
History and Basic Concepts of Full-Endoscopic Spine Surgery
1 Introduction
2 History of Full-Endoscopic Spine Surgery
2.1 Foundation of Endoscopic Spine Surgery
2.2 First Generation of Endoscopic Spine Surgery
2.3 Second Generation of Endoscopic Spine Surgery
2.4 Third Generation of Endoscopic Spine Surgery
2.5 Fourth Generation of Endoscopic Spine Surgery
3 Basic Concepts of Full-Endoscopic Spine Surgery
4 Summary
References
Transforaminal Endoscopic Lumbar Discectomy
1 Introduction
1.1 Basic Principle
1.2 Nomenclature
1.3 Evidence
1.4 Barriers to Entry to the Endoscopic Spine Surgery
1.5 Overcoming the Learning Curve
2 Indications
3 Step-by-Step Technique
4 Technical Keys to Success
5 Perioperative Considerations
6 Dural Risk and Incomplete Decompression
7 Transforaminal Endoscopic Discectomy for Different Situations
7.1 Migrated Disc Herniation
7.2 Recurrent Disc Herniation
7.3 Foraminal/Extraforaminal Disc Herniation
7.4 Upper Lumbar Level Disc Herniation
7.5 Disc Herniation at the L5–S1 Level
8 Summary
References
Interlaminar Endoscopic Lumbar Discectomy
1 Introduction
2 Indications
3 Applied Anatomy
3.1 Interlaminar Window
3.2 Ligamentum Flavum
3.3 Intervertebral Foramen Size
3.4 Intervertebral Foramen Nerve Root Exit
3.5 Herniated Disc Position
4 Step-by-Step Technique
4.1 Preoperative Planning
4.2 Anesthesia
4.3 Positioning and Setting
4.4 Discography
4.5 Target Point and Needle Insertion
4.6 Epidurogram
4.7 Working Channel Establishment
4.8 Ligamentum Flavum Approach
4.9 Disc Herniation Access
4.10 Annulus Approach
5 Complications
5.1 Dural Tear
5.2 Early Relapse
5.3 Nerve Injury
5.4 Vascular Injury
5.5 Infection
6 Summary
References
Full Endoscopic Decompression in Thoracolumbar Stenosis
1 Introduction
2 Indications
3 Contraindications
4 Surgical Technique
4.1 Preoperative Planning
4.1.1 Plain Radiograph
4.1.2 Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan
4.2 Anesthesia and Position
4.3 Special Surgical Instruments (Fig. 1)
4.4 Surgical Steps
4.4.1 Skin Incision
4.4.2 Working Cannula Docking and Insertion of Endoscope
4.4.3 Anatomical Points
4.4.4 Bony Decompression
4.4.5 Removal of the Ligament Flavum and Confirmation of the Decompressed Neural Structures
4.5 Postoperative Care
4.6 Consideration for Thoracic Decompression
5 Complications
5.1 Incomplete Decompression and Excessive Facet Violation
5.2 Intraoperative Bleeding
5.3 Incidental Durotomy
5.4 Injury to Neural Structures/Transient Dysesthesia
6 Illustrative Cases
6.1 Case 1. Severe Lumbar Canal Stenosis Combined with Disc Herniation (Fig. 8)
6.2 Case 2. Multilevel Endoscopic Lumbar Canal Decompression (Fig. 9)
6.3 Case 3. Ossification of ligament Flavum in Lumbar Area (Fig. 10)
7 Summary
References
Transforaminal Endoscopic Lumbar Lateral Recess Decompression
1 Introduction
2 Indications
3 Surgical Technique
3.1 Preoperative Planning
3.2 Surgical Steps
3.2.1 Extreme Lateral Transforaminal Approach with Foraminoplasty
3.2.2 Partial Upper Pediculectomy of the Lower Pedicle Following Vertical Foraminal Widening
3.2.3 Removal of the Ligamentum Flavum in the Lateral Portion of the Spinal Canal
3.2.4 Removal of the Ligamentum Flavum in the Dorsal Portion of the Spinal Canal
3.2.5 Ventral Decompression (If Necessary)
4 Case illustration
4.1 Case 1
4.2 Case 2
5 Complication Avoidance
6 Summary
References
Transforaminal Endoscopic Lumbar Foraminotomy/Foraminoplasty
1 Main Script
2 Technical Description
3 Case Illustration
References
Anterior Percutaneous Endoscopic Cervical Discectomy
1 Introduction
2 Indications and Contraindications
3 Step-by-Step Technique
3.1 Patient Preparation
3.2 Anterior Percutaneous Cervical Approach Under Fluoroscopic Guidance
3.3 Selective Disc Decompression Under Endoscopic Visualization
4 Perioperative Consideration
5 Case Illustration
6 Summary
References
Full Endoscopic Posterior Cervical Spinal Surgery
1 Introduction
2 Indications and Contraindications
2.1 PECF
2.2 Posterior Endoscopic Cervical Decompressive Laminectomy (Laminotomy)
3 Step-by-Step Technique
3.1 Anesthesia and Position
3.2 Surgical Approach
3.3 Full Endoscopic PCF (Conventional Approach) (Figs. 2b and 3b)
3.3.1 Skin Entry Point (Fig. 4)
3.3.2 Sequential Dilation and Working Cannula Insertion
3.3.3 Soft Tissue Dissection and Anatomical Landmark Confirmation (Fig. 5, Video 1)
3.3.4 Partial Laminotomy and Facet Joint Removal (Fig. 5, Video 1)
3.3.5 Lower Level Lamina and Superior Articular Process (SAP) Broad Bone Drilling (Fig. 6, Video 2)
3.3.6 Thinned Lamina and SAP Removal (Fig. 7, Video 3)
3.3.7 Additional Decompression (Fig. 8, Video 3)
3.3.8 Ligamentum Flavum and Peridural Adhesion Removal (Fig. 9, Video 4)
3.3.9 Final Exploration and Closure
3.4 IPV Approach for PECF
3.4.1 Skin Entry Point
3.4.2 Inclined Surgical Route (Fig. 11)
3.4.3 Inclined Vertebrotomy for Ventral Foraminal Decompression (Fig. 12, Video 5)
3.4.4 Complete Neural Decompression Confirmation (Fig. 13, Video 5)
3.4.5 Effect of IPV on Facet Joint Preservation
3.5 Full Endoscopic Posterior Cervical Decompressive Laminectomy
3.5.1 Skin Entry Point and Working Cannula Insertion (Fig. 16)
3.5.2 Soft Tissue Dissection and Anatomical Landmark Identification (Fig. 17, Video 6)
3.5.3 Marginal Upper and Lower Level Lamina Drilling (Figs. 17 and 18, Video 6)
3.5.4 Hypertrophied Ligamentum Flavum Detachment and Removal (Fig. 19, Video 6)
4 Postoperative Considerations
5 Illustrated Cases
6 Summary (Surgical Tips and Pitfalls)
6.1 Posterior Endoscopic Surgical Approach
6.2 Facet Joint Preservation During PECF
6.3 Incomplete Foraminal Decompression
6.4 Spinal Cord Injury Prevention During Posterior Cervical Decompressive Laminectomy
References
Transforaminal Endoscopic Thoracic Discectomy and Decompression
1 Introduction
2 Indications
3 Surgical Technique
3.1 Step 1. Set Up
3.1.1 Instrument
3.1.2 Position and Anesthesia
3.2 Step 2. Skin Entry and Initial Needle Placement
3.3 Step 3. Foramioplasty and Decompression
4 Case Illustration
5 Complication Avoidance
6 Summary
References
History and Basic Concepts of Unilateral Biportal Endoscopic Surgery (UBE)
1 A History of Unilateral Biportal Endoscopic Surgery
1.1 The Inspiration, Initiation, and Innovations of Unilateral Biportal Endoscopic (UBE) Spine Surgery
1.2 UBE History in Korea
2 Basic Concepts of Unilateral Biportal Endoscopic Surgery
2.1 Introduction
2.2 Main Concepts of UBE
2.2.1 Minimal Invasiveness
2.2.2 Fluid-Medium Surgery and Advantages
2.2.3 Hydrostatic Pressure and Control
2.2.4 View Magnification
2.2.5 Free Handling of Spinal Instruments and Learning Curve
2.2.6 Triangular Formation
2.2.7 Operator Only Without Assistants
2.2.8 Usefulness and Riskiness of Radiofrequency Ablation
2.2.9 Radiation Exposure
2.2.10 Future of UBE: Expansion of Indications
3 Conclusion
References
Unilateral Biportal Endoscopy for Lumbar Disc Herniation and Stenosis
1 Introduction
2 Step-by-Step Technique
2.1 Concept of UBE
2.2 Lumbar Spinal Stenosis
2.2.1 Skin Marking and Portal Establishment
2.2.2 Bone Working (Fig. 4 and Video 1)
2.2.3 LF Resection (Fig. 5 and Video 2)
2.3 Lumbar Disc Herniation
2.3.1 Skin Marking and Portal Establishment
2.3.2 Bone Working and Partial LF Resection (Fig. 6 and Video 3)
2.3.3 Discectomy (Fig. 7 and Video 4)
3 Postoperative Consideration
3.1 Dural Tear
3.2 Postoperative Hematoma
3.3 Fluid-Induced Complications
4 Case Illustration
4.1 Case 1: Lumbar Spinal Stenosis
4.2 Case 2: Lumbar Disc Herniation
5 Summary
References
Unilateral Biportal Endoscopic Surgery (UBE) for Cervical and Thoracic Spine
1 Introduction
2 Indications
3 Special UBE Instruments
4 Anesthesia and Position
5 Step-by-Step Technique (Schematic Illustration, More Than Four Figures)
5.1 Cervical UBE Decompression (Left-Side Approach, C6–7 Level)
5.2 Thoracic UBE Decompression (Left-Side Approach, HTD T12/ L1)
6 Perioperative Consideration and Case Illustration (If Applicable)
6.1 Cervical Case Presentation
6.2 Thoracic Case Presentation
7 Summary
References
Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion
1 Introduction
2 Indications
3 Step-by-Step Technique
3.1 Uniportal Full Endoscopic, Facet Sacrificing Posterolateral Transforaminal Lumbar Interbody Fusion
3.1.1 Step 1: Docking of Uniportal Stenosis Dimension Endoscope on Pars Interarticularis
3.1.2 Step 2: Resection of Inferior Articular Process: Inside-Out Versus Outside-In Approach
3.1.3 Step 3: Resection of Superior Articular Process
3.1.4 Step 4: Flavecectomy and Decompression of Neural Elements
3.1.5 Step 5: Intervertebral Disc Preparation and Cage Insertion
4 Postoperative Consideration and Case Illustration
5 Summary
References
Biportal Endoscopic Lumbar Interbody Fusion
1 Introduction
2 Indications
3 Step-by-Step Technique
3.1 Skin Incision and Making Two Portals
3.2 Bone Work with Nerve Root Decompression
3.3 Discectomy Endplate Preparation
3.4 Cage Insertion
3.5 Percutaneous Pedicle Screw Insertion
4 Postoperative Consideration
5 Case Illustration
6 Summary
References
Part III: Minimally Invasive Spinal Procedure
Overview of Minimally Invasive Spine Surgery with the Tubular Retractor
1 Introduction
2 Main Text
2.1 Lumbar Microdiscectomy
2.2 Lumbar Decompression
2.3 Far Lateral Approach Using the Tubular Retractor
2.4 Transforaminal Lumbar Interbody Fusion
2.5 Thoracic Spine Surgery
2.6 Posterior Cervical Foraminotomy
2.7 Posterior Cervical Central Decompression
3 Summary
References
Minimally Invasive Spinal Decompression for Lumbar Spine
1 Introduction
2 Indications
2.1 Microdiscectomy (Interlaminar Approach)
2.1.1 Step-by-Step Technique
Surgical Position
Preoperative Spine Marking
Incision
Subperiosteal Dissection
Developing the Interspace
Epidural Fat and Nerve Root Damage
Interlaminar Surgery
Intervertebral Disc Excision
Removal of Intervertebral Disc Fragments
Considerations During Surgery
Suture
2.2 Paraspinal Microdiscectomy (Far Lateral Approach)
2.3 Unilateral Approach Bilateral Decompression (ULBD)
2.3.1 Step-by-Step Technique
Surgical Equipment and Instruments
Surgeon Position
Incision
Exposure
Laminectomy
Ipsilateral Laminectomy
Contralateral Laminectomy
Ipsilateral Lateral Recess Decompression
3 Postoperative Consideration and Case Illustration
3.1 Complications
3.2 Case Illustration
4 Summary
References
Minimally Invasive Spinal Decompression for Cervical Spine
1 Introduction
2 Anatomical Consideration
2.1 Anterior Cervical Microforaminotomy
2.1.1 Indication and Contraindication
2.1.2 Step-by-Step Technique
Step 1. Patient Position
Step 2. Skin Incision and Dissection
Step 3. Foraminotomy with Nerve Decompression
Transuncal Approach
Upper Vertebral Transcorporeal Approach (UVTC)
Confirmation of Decompression and Decision to End Surgery
2.1.3 Postoperative Consideration and Case Illustration
Complications
Case Illustration (Fig. 5)
2.2 Posterior Cervical Foraminotomy
2.2.1 Indication and Contraindication
2.2.2 Step-by-Step Technique
Step 1. Position and Localization
Step 2. Serial Dilation and Placement of Tubular Retractor
Step 3. Ipsilateral Laminotomy
Step 4. Perform the Foraminal Decompression and Discectomy
Step 5. Wound Closure and Postoperative Care
2.2.3 Postoperative Consideration and Case Illustration
Complications
3 Summary
References
Minimally Invasive Transforaminal Lumbar Interbody Fusion
1 Introduction
2 Step-by-Step Technique
2.1 Preparation for Surgery
2.2 Patient Position
2.3 Skin Marking
2.4 Skin Incision and Tubular Retractor Application
2.5 Facetectomy
2.6 Decompression of the Central Canal
2.7 Discectomy
2.8 Cage Insertion
3 Postoperative Consideration and Case Illustration
4 Summary
References
Anterior Lumbar Interbody Fusion (ALIF)
1 Introduction
2 History
3 Indications and Contraindications
4 Surgical Technique
5 Retroperitoneal Approach
6 Transperitoneal Approach
7 Complications
8 Summary
References
Oblique Lumbar Interbody Fusion (OLIF)
1 Introduction
2 Indications and Contraindications
2.1 Indications
2.2 Relative Contraindication
2.3 Contraindications
3 Step-by-Step Technique
3.1 OLIF L2–5 (Anterior to Psoas Approach) [1–3]
3.1.1 Preoperative Plan
3.1.2 Position
3.1.3 Skin Incision
3.1.4 Abdominal Muscle Dissection
3.1.5 Retroperitoneal Approach
3.1.6 Psoas Muscle Retraction
3.1.7 Retractor Placement
3.1.8 Annulotomy and Discectomy
3.1.9 Contralateral Annulus Release
3.1.10 Sequential Trial Size Selection
3.1.11 Endplate Preparation and Cage Insertion
3.1.12 Closure
3.2 OLIF L5–S1 (Between the Iliac Bifurcation Approach: BIB Approach) [8–10]
3.2.1 Preoperative Plan
3.2.2 Position
3.2.3 Skin Incision
3.2.4 Abdominal Muscle Dissection
3.2.5 Retroperitoneal Approach
3.2.6 Annulotomy and Discectomy
3.2.7 Sequential Trial Size Selection and Cage Insertion
3.2.8 Closure
4 Postoperative Consideration and Case Illustration
4.1 Case Illustration
5 Summary
References
Minimally Invasive Adult Spinal Deformity Correction
1 Introduction
2 Indications
3 Lateral Lumbar Interbody Fusion
4 Lumbosacral Interbody Fusion Option
5 Percutaneous Pedicle Screw Placement
6 Outcomes and Complications
7 Summary
References
Spinal Blocks and Radiofrequency Techniques
1 Epidural Steroid Injection
1.1 Introduction
1.2 Anatomy
1.3 Medication
1.4 Indication and Contraindication
1.5 Interlaminar Approach
1.5.1 Technique: Cervical Interlaminar Epidural Injection
1.5.2 Technique: Lumbar Interlaminar Epidural Injection
1.5.3 Technique: Caudal Block
1.5.4 Complication
1.6 Transforaminal Approach and Selective Nerve Root Block (SNRB)
1.6.1 Technique: Cervical Transforaminal Epidural Injection
1.6.2 Technique: Lumbar Transforaminal Epidural Injection
1.6.3 Technique: Sacral Transforaminal Epidural Injection
1.6.4 Complication of Transforaminal Approach
2 Facet Injection
2.1 Introduction
2.2 Anatomy
2.3 Indication and Contraindication
2.4 Cervical Facet Injection
2.4.1 Cervical Intra-Articular Facet Injection
2.4.2 Cervical Medial Bundle Branch Block (MBBB)
2.4.3 RFA of Cervical Medial Branch
2.5 Lumbar Facet Injection
2.5.1 Lumbar Intra-Articular Facet Injection
2.5.2 Lumbar Medial Branch Block
2.5.3 RFA of Lumbar Medial Branch
2.6 Complication of Facet Injections
References
Percutaneous Epidural Neuroplasty
1 Introduction
2 Classifications
3 Indications
4 Preoperative Preparation
5 Patient Positioning and Sacral Hiatus Puncture
6 Catheter Advancement
7 Adhesiolysis
8 Management of Dura Tears
9 Postoperative Management
10 Conclusion
References
Percutaneous Transforaminal Annuloplasty
1 Introduction
2 Diagnosis
3 Indications
4 Surgical Technique
4.1 Step 1. Set up
4.1.1 Instrument
4.1.2 Position and Anesthesia
4.2 Step 2. Landing of the Working Sheath (as Shallow as Possible)
4.3 Step 3. Annuloplasty
5 Case Illustration
6 Complication Avoidance
7 Summary
References
SELD, Trans Sacral Epiduroscopic Lumbar Decompression
1 Introduction
2 Surgical Instruments
3 Surgical Procedures
4 Discussion
5 Conclusion
References
Vertebroplasty and Kyphoplasty
1 Introduction
2 Indications
2.1 OVCF
2.2 Neoplasm
3 Contraindications
4 Step-by-Step Technique
5 Postoperative Consideration and Case Illustration
5.1 Complications
6 Summary
References
Part IV: Motion Preservation Techniques
History and Bascic Concepts of Motion Preservation Tehniques
1 Introduction
2 Main Text
3 Summary
References
Artificial Disc Replacement for Cervical Spine
1 Introduction
2 Indications
2.1 Step-by-Step Technique (Schematic Illustration, More Than Four Figures)
2.1.1 Position
2.1.2 Incision and Dissection
2.1.3 Disc Space Preparation
2.1.4 Artificial Disc Placement
2.1.5 Closure
3 Postoperative Consideration and Case Illustration (if Applicable)
3.1 Segmental Range of Motion
3.2 Adjacent Segment Degeneration
3.3 Heterotopic Ossification
3.4 Subsidence of Implant
3.5 Osteolysis
4 Summary
References
Total Disc Replacement in Lumbar Degenerative Disc Diseases
1 Introduction
2 Indications
3 Step-by-Step Technique
3.1 Implants
3.2 Preoperative Evaluation
3.3 Preoperative Preparation and Anesthesia
3.4 Surgical Approach
3.4.1 Position
3.4.2 Level Marking
3.4.3 Selection of Surgical Approach Side
3.4.4 Skin Incision
3.4.5 Rectus Muscle Incision
3.4.6 Retroperitoneal Dissection
3.4.7 Vessel Dissection
3.4.8 Discectomy and End Plate Preparation
3.4.9 Placement of Implant
3.4.10 Annulus Suture and Wound Closure
3.4.11 Anterior Transperitoneal Approach
4 Postoperative Consideration and Case Illustration
4.1 Postoperative Care
4.2 Revision Strategy
4.3 Complications
5 Case Illustration
6 Summary
References
Posterior Dynamic Stabilization (Interspinous Process Device)
1 Introduction
2 Step-by-Step Technique
3 Summary
References
Posterior Dynamic Stabilization (Screw and Dynamic Rod)
1 Introduction
1.1 Graf Ligament System
1.2 Dynesys
1.2.1 Indications
1.2.2 Contraindications
1.2.3 Surgical Techniques
1.2.4 Performance
1.2.5 Clinical Results
1.2.6 Consideration
1.3 PEEK Rod for CD Horizon Legacy
1.4 BioFlex System
1.5 Cosmic Screw
2 Surgical Technique
3 Summary: Present and Future of Posterior Dynamic Stabilization with Screw and Dynamic Rod
References
Part V: New Technologies in Minimally Invasive Spine Surgery
Navigation Guided Spine Surgery
1 Introduction
2 Overview of Spinal Navigation
2.1 Conventional Intraoperative Spinal Images
2.2 Development of Image-Guided Spinal Navigation
3 Navigation-Guided Spine Surgery
3.1 Components of the  Navigation System
3.2 Using an Image Guidance Spinal Navigation System in the Operating Room
3.2.1 Installation of the Image Guidance Spinal Navigation System
3.2.2 Image Scanning
3.3 Registration of Surgical Instruments
4 Advantages of Image-Guided Navigation in Spine Surgery
4.1 Safety and Accuracy of Spinal Instrumentation with an Image Guidance Navigation System
4.2 Surgical Resection of Tumors with an Image-Guided Navigation System
4.3 Radiation Exposure
5 OLIF-ONE
5.1 Surgical Procedure of OLIF-ONE
5.2 Surgical Steps for OLIF-ONE
5.3 Learning Curve Analysis of OLIF-ONE
5.4 Case
6 Summary
References
Robotic Spine Surgery
1 Introduction
2 Indications
3 Step-by-step technique
3.1 Setup
3.2 Registration
3.3 Surgical planning
3.4 Screw instrumentation
4 Surgical Procedures (Fig. 11)
5 Postoperative Consideration and Case Illustration
6 Summary
References
Artificial Intelligence and Minimally Invasive Spine Surgery
1 Introduction
2 Application of AI in Minimally Invasive Spine Surgery (MISS)
3 Computer-Aided Diagnosis and Detection
4 Computer-Aided Decision Support and Prognosis Prediction
5 Computer-Aided Surgical Education and Assessment
6 Limitations and Future Directions
7 Summary
References