Mayer Minimally Invasive Spine Surgery

A Surgical Manual
2. Auflage 2006
ISBN: 978-3-540-29490-0
Verlag: Springer
Format: PDF
Kopierschutz: Wasserzeichen (»Systemvoraussetzungen)

E-Book, Englisch, 492 Seiten, eBook

Don’t miss it! The second, completely revised and expanded edition of the successful surgical manual on minimally invasive spine surgery includes 51 chapters (including more than 20 new chapters) covering all current minimally invasive techniques in spine surgery. A complete survey of all microsurgical and endoscopic techniques with a special focus on semi-invasive injection techniques for diagnostic and therapeutic purposes in low back pain is given. The clear chapter structure with terminology, history, surgical principles, advantages/disadvantages, indications, access principles, complications, and results facilitates navigation through the manual. Topics include the principles of microsurgical and endoscopic treatment, spinal navigation and computer-assisted surgery, minimally invasive reconstruction, fusion, dynamic stabilization in fractures, degenerative disc disease, spinal stenosis, low back pain and deformities. The didactic presentation of surgical steps makes the reader familiar with all types of new minimally invasive techniques in clinical use or still in ongoing clinical trials such as minimally invasive spine arthroplasty.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Mayer, H. Michael

Mayer, Michael

Inhaltsverzeichnis

General: Minimally Invasive Spine Surgery.- Technologic Advances of Surgical Microscopes for Spine Surgery.- Spinal Microsurgery - A Short Introduction.- Microsurgical Instruments.- Operating Room Setup and Handling of the Microscope.- Computer Assisted Minimal Invasive Spine Surgery - State of the Art. Techniques: Cervical Spine: Odontoid: The Technique of Transoral Odontoidectomy.- Microsurgical Treatment of Odontoid Fractures. Disc Surgery / Decompression: Microsurgery of the Cervical Spine: The Anterior Approach.- Anterior Cervical Foraminotomy.- Functional Segmental Reconstruction with the Bryan Total Cervical DiscTM.- Microsurgical Total Cervical Disc Replacement. Microsurgical Posterior Approaches to the Cervical Spine. Microsurgical C1/2 stabilization. Thoracic/Thoraco-Lumbar Spine: General Techniques: The Microsurgical Anterior Approach to T5–T10 (Mini-TTA).- Microsurgical Anterior Approach to the Thoraco-Lumbar Junction.- Anatomic Principles of Thoracoscopic Spine Surgery.- Principles of Endoscopic Techniques in the Thoracic and Lumbar Spine.- Biomechanical Requirements in Minimally Invasive Spinal Fracture Treatment. Deformities: Thoracoscopic Approaches in Spinal Deformities and Trauma. Thoracoscopic Techniques in Spinal Deformities.- Mini-open Endoscopic Excision of Hemivertebrae.- Fractures: Thoracoscopic-Assisted Anterior Approach to Thoracolumbar Fractures.- Minimal Invasive but Open Approach to the Thoracic and Lumbar Spine.- Percutaneous Vertebroplasty in Osteoporotic Vertebral Fractures.- Microsurgical Open Vertebroplasty and Kyphoplasty.- Pecutaneous Vertebroplasty in Traumatic Fractures. Lumbar Spine: Low Back Pain: Semi-Invasive Procedures for Low Back Pain and Disc Herniation. Disc: Intradiscal Electrothermal Therapy (IDET).- Microtherapy In Low Back Pain.- Principles of MicrosurgicalDiscectomy in Lumbar Disc Herniations.- The Microsurgical Interlaminar, Paramedian Approach.- The translaminar approach.- The Lateral, Extraforaminal Approach.- Transforaminal Endoscopic Discectomy.- Microscope-assisted Percutaneous Technique as Minimally Invasive Approach to the Posterior Spine.- Arthroscopic and Endoscopic Spinal Surgery via a Posterolateral Approach.- The Endoscopic Interlaminar Approach.- Outpatient Microsurgical Lumbar Discectomy and Microdecompression Laminoplasty. Disc Reconstruction: Nucleus Reconstruction by Autologeous Chondrocyte Transplantation.- Autologous Disc Chondrocyte Transplantation.- The ALPA Approach for Minimal Invasive Nucleus Pulposus Replacement. Mini-open Midline Accesses for Lumbar Total Disc Replacement. Spinal Stenosis: Microsurgical Decompression of Acquired (Degenerative) Central and Lateral Spinal Canal Stenosis. Fusion: Microsurgical Anterior Lumbar Interbody Fusion (MINIALIF) - The Retroperitoneal Approach to L2/3, L3/4, and L4/5.- Microsurgical Anterior Lumbar Interbody Fusion: The Transperitoneal Approach to L5/S1.- Minimal invasive 360° Lumbar Fusion.- The Anterior Extraperitoneal Video-Assisted Approach to the Lumbar Spine. Dynamic Stabilization: Minimally invasive Dynamic Stabilization of the Lumbar Motion Segment with an Interspinous Implant.- Technical and Anatomical Considerations for the Placement of a Posterior Interspinous Stabilizer. -Elastic Microsurgical Stabilization with Posterior Shock Absorber.

Leseproben

4 Microsurgical Instruments ( p. 16)

A. Korge
As in all surgical fields, an enormous tendency has occurred recently toward minimizing both surgical procedures as well as surgical approaches. The reasons for miniaturized approaches include a reduced infection rate due to shortened skin incisions, less cosmetic alterations, as well as the fact that in the majority of cases, small and localized pathologies only need small and limited approaches.

In addition, small incisions need less time for wound closure, thus reducing the overall time of surgery [4]. This tendency is also found in spine surgery with an increasing shift frommacrosurgery tomicrosurgery [1, 2, 3, 5]. Microsurgery has become quite popular, especially in surgical procedures within the spinal canal [3], and has been established within recent decades basically due to the development of efficient optical aids such as powerful and effective surgical microscopes which are being continuously improved.

However, the use of microscopes in spine surgery delivered a new intermedium between the surgeon’s eye and the operating field, thus influencing simultaneously the individual visual axis between the surgeon’s eye and his hands. Therefore, the surgeon’s line of vision was restricted and the field of vision became smaller and limited. In addition, the line of vision of a microscope is perpendicular to the surgical area to be operated on.

Consequently, the configuration of surgical instruments had to be modified (e.g., bayonet-shaped), as well as their basic dimensions (e.g., smaller and longer), in order to fulfill the specific requirements of microscope-assisted surgery. Depending on the anatomical area and the number of segments being approached, surgery can be started with either microscopic or macroscopic techniques. Usually, mono- or bisegmental pathologies on the lumbar spine (disc herniation, lumbar spinal stenosis) can be done by a skin-to-skin technique with microscope assistance from beginning to end.

In multisegmental decompression surgery, for example due to lumbar spinal stenosis, initial macroscopic preparation down to the interlaminar windows and subsequent use of the microscope might save time.

4.1 Classification of Instruments
Instruments for spinal microsurgery can usually be divided into two major groups:

1. The first group is especially related to the approach from the skin down to the spinal canal, including skin opening, traversing soft tissue subcutaneous, transfascial, and paravertebral to the interlaminar window, and entering the spinal canal.

2. The second group is related to surgical procedures within the spinal canal and within the intervertebral disc space. Some instruments are effective in both groups (cautery, high-speed drills, suction devices), as ismentioned later on.

4.1.1 Instruments Related to the Approach

4.1.1.1 Instruments for Wound Opening
There is basically no big difference betweenmicroscopic and macroscopic instruments for opening the skin even when using the microscope from the beginning. Standardized incision scalpels serve to open the skin and to traverse the subcutaneous tissue. Forceps of standard size and length can be used for skin and tissue retraction, however, delicate forceps such as Adson forceps are more comfortable under microscope assistance.