RESUMO
Minimally invasive techniques have become part of the spine surgeons' armamentarium and are currently utilized to treat many conditions involving the cervical, thoracic, lumbar and sacral spine. Surgical treatment of severe degenerative conditions such as multilevel spinal stenosis, tandem stenosis, combination of stenosis or disk herniation and spondylolisthesis at adjacent spinal levels, as well as extensive infections or hematomas, may require a multilevel tailored approach with all the challenges that such surgical planning entails. Although the use of minimally invasive tubular decompressive procedures has gained widespread popularity in the recent years, the adoption of such techniques during multilevel spine surgery can be at times challenging. A careful tailored selection of the surgical approach that better fits needs and expectations of the patient is therefore consequential to achieve good clinical and radiological outcome without compromising efficiency and results. Many surgical techniques have been described in literature but very few reports on the use of combined tubular approached are currently present. We therefore present an illustrative review of techniques for tubular laminectomies and combined approaches that can be utilized in the surgical treatment of multilevel spinal conditions. Illustrative cases documenting common and less common indications for the use of minimally invasive laminectomies are also presented.
RESUMO
We present an illustrative report on the use of a minimally invasive, muscle-sparing, direct pars defect decompression with transforaminal lumbar interbody fusion (TLIF) and instrumentation for the treatment of low-grade adult isthmic spondylolysis with spondylolisthesis and discuss the surgical challenges and nuances associated with the technique.
RESUMO
We present a case of symptomatic heterotopic bone formation following revision of posterolateral lumbar fusion/instrumentation and "off-label" use of recombinant human bone morphogenetic protein-2, treated successfully with the use of a minimally invasive tubular approach.
Assuntos
Proteína Morfogenética Óssea 2/farmacologia , Vértebras Lombares/cirurgia , Ossificação Heterotópica/cirurgia , Fusão Vertebral , Fator de Crescimento Transformador beta/farmacologia , Idoso , Proteína Morfogenética Óssea 2/metabolismo , Descompressão/métodos , Feminino , Humanos , Vértebras Lombares/efeitos dos fármacos , Região Lombossacral/cirurgia , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/tratamento farmacológico , Proteínas Recombinantes/metabolismo , Proteínas Recombinantes/farmacologia , Reoperação/métodos , Fusão Vertebral/métodos , Fator de Crescimento Transformador beta/metabolismoRESUMO
We present a rare case of symptomatic cystic lumbar spinal epidural lipomatosis that required surgical treatment via a minimally invasive tubular laminectomy. To our knowledge this is the first pathology confirmed report of compressive cystic lumbar spinal epidural lipomatosis available in literature.
Assuntos
Espaço Epidural/patologia , Lipomatose/patologia , Doenças da Coluna Vertebral/patologia , Idoso , Cistos/patologia , Cistos/cirurgia , Espaço Epidural/cirurgia , Feminino , Humanos , Laminectomia , Lipomatose/cirurgia , Região Lombossacral/cirurgia , Imageamento por Ressonância Magnética , Masculino , Doenças da Coluna Vertebral/cirurgiaRESUMO
This report presents a modified use of multiple tubular retractors (that limits issues related to the sequential redocking of tubular systems) that may prove helpful in cases where a minimally invasive approach is utilized for the treatment of multilevel lumbar stenosis.