Minimally invasive spine technology and minimally invasive spine surgery: a historical review.

The trend of using smaller operative corridors is seen in various surgical specialties. Neurosurgery has also recently embraced minimal access spine technique, and it has rapidly evolved over the past 2 decades. There has been a progression from needle access, small incisions with adaptation of the microscope, and automated percutaneous procedures to endoscopically and laparoscopically assisted procedures. More recently, new muscle-sparing technology has come into use with tubular access. This has now been adapted to the percutaneous placement of spinal instrumentation, including intervertebral spacers, rods, pedicle screws, facet screws, nucleus replacement devices, and artificial discs. New technologies involving hybrid procedures for the treatment of complex spine trauma are now on the horizon. Surgical corridors have been developed utilizing the interspinous space for X-STOP placement to treat lumbar stenosis in a minimally invasive fashion. The direct lateral retroperitoneal corridor has allowed for minimally invasive access to the anterior spine. In this report the authors present a chronological, historical perspective of minimal access spine technique and minimally invasive technologies in the lumbar, thoracic, and cervical spine from 1967 through 2009. Due to a low rate of complications, minimal soft tissue trauma, and reduced blood loss, more spine procedures are being performed in this manner. Spine surgery now entails shorter hospital stays and often is carried out on an outpatient basis. With education, training, and further research, more of our traditional open surgical management will be augmented or replaced by these technologies and approaches in the future.

Medieval neurosurgery: contributions from the Middle East, Spain, and Persia.

Modern neurological and spinal surgical techniques have been developed on the foundations established by predecessors. Modern 21st century neurosurgery begins in the Babylonian period, with the Edwin Smith papyrus. Throughout history, periods of enlightenment have resulted in advances in knowledge and understanding that have served as stepping stones for generations to come. As in other fields, in neurosurgery these periods of "enlightenment" have occurred in a variety of civilizations and time periods.

Effect of hemostasis and electrosurgery on the development and evolution of brain tumor surgery in the late 19th and early 20th centuries.

Hemostatic options available to the surgeon in the late 19th and early 20th centuries were limited. The surgical ligature was limited in value to the neurological surgeon because of the unique structural composition of brain tissue as well as the approaches and operating angles used in this type of surgery. In this manuscript the authors review the options available and the evolution of surgical hemostatic techniques and electrosurgery in the late 19th and early 20th centuries and the impact of these methods on the surgical management of tumors of the brain and its coverings.

The use of closed-suction irrigation systems to manage spinal infections.

OBJECT: Management of infection in the hardware system-fixated spine has proven to be problematic. In many cases, instrumentation is required to provide stability or to maintain correction of deformity, and removal could be hazardous. The authors describe the use of closed continuous irrigation to treat spinal wound infections in patients with fixation systems; irrigation can be used in all parts of the spine with excellent results. METHODS: The authors conducted a retrospective chart-based review of cases in which spinal instrumentation procedures were performed consecutively during a 10-year period. Infection developed in 36 patients. The infections involved the cervical, thoracic or thoracolumbar, and lumbar regions. Anterior and posterior drains were placed in one patient. In one patient refractory infections responded to replacement of the dual-inflow port drainage system. In all cases the wound infection completely resolved. There were no cases that required the removal of the fusion mass or instrumentation. In all cases progression to solid fusion was achieved. CONCLUSIONS: Closed irrigation systems can be used effectively to manage anterior or posterior cervical, thoracic, and lumbar wound infections. These systems preclude the explantation of the instrumentation and allow spinal stability to be preserved. The authors noted no evidence of recurrent infection or failed fusion.

Occipital-cervical fusion using the Locksley intersegmental tie bar technique: long-term experience with 19 patients.

BACKGROUND CONTEXT: The management of lesions at the craniocervical junction presents unique difficulties for the spine surgeon. The complexity of this region creates a variety of mechanical forces that challenge any fusion construct. An understanding of the ligamentous, bone and vascular structures in this region is critical. PURPOSE: To describe a method of occipital-cervical fusion with long-term follow-up. STUDY DESIGN/SETTING: Retrospective case series. PATIENT SAMPLE: Twenty-one consecutive patients with craniocervical compression and/or instability who were treated using the Locksley intersegmental tie bar technique. OUTCOME MEASURES: Neurologic function, fusion, postoperative complications. METHODS: Patients with craniocervical instability underwent occipital-cervical fusion using the Locksley intersegmental tie bar technique. The pathologic processes causing compression and/or instability at the craniocervical junction, as well as the patients' pre- and postoperative neurologic status, are reported. RESULTS: Solid fusion was attained in all 19 patients surviving at 2 years. Two patient deaths were reported in this series in the early postoperative period because of systemic disease. CONCLUSIONS: This approach allows for rigid, immediate stabilization of this region. An external orthosis is most often not required. This technique has unique applicability to patients where the normal ligamentous and bone structures are weakened because of underlying disease or injury.

History of spinal surgery: one neurosurgeon's perspective.

Spinal surgery has advanced from decompression procedures to complex spinal reconstruction and internal stabilization within the last 25 years, as a result of a broad-based technological boom that began in the 1970s with the advent of spinal computerized tomography and magnetic resonance imaging. These technological advances have coincided with, and developed as a result of, the concomitant rise of a complex, economically driven consortium of innovative surgeons and researchers, academic institutions, government agencies, and private industry, to form a Medical-Industrial Complex (MeIC). A major growth industry has formed, resulting in an overall societal benefit. Nevertheless, it has impacted graduate medical education and has significantly increased the cost of treating spinal disorders. Back pain and spinal disorders are a major societal health problem that is associated with a high demand for treatment services. There is a potential for abuse as well as a benefit in offering these services. The MeIC has contributed to the overall rise in the cost of health care insurance and in the migration of manufacturing jobs abroad as a solution for lowering production costs. The increased cost has had a negative impact on local and regional economies.

The evolution of posterior cervical and occipitocervical fusion and instrumentation.

The past several decades have been the setting for a remarkable evolution of spinal instrumentation technology. The advancements that have been made have allowed previously complex disorders of the cervical spine, the atlantoaxial articulation, and the occipitocervical junction to be managed more effectively with direct methods of internal fixation and arthrodesis. This has resulted in improvements in patient outcomes and fusion success rates. The improved strength of instrumentation constructs allows minimal, if any, external bracing, obviating the need for a halo orthosis in many cases. In this paper the authors review key events that have occurred in neuroimaging, biomechanical testing, and the development of fusion and instrumentation constructs.

Carpal tunnel syndrome.

Preview Data entry, bar-code scanning at a grocery store checkout, playing the drums-these are all activities that may precipitate carpal tunnel syndrome, the most common entrapment neuropathy. Beyond cessation of repetitive wrist motions, treatment options range from corticosteroid injection to surgical intervention. Which form of therapy is best for your patient? Which tests are most useful in clinical evaluation? The authors address these questions in this overview of diagnosis and treatment.