Double tubular minimally invasive spine surgery: a novel technique expands the surgical visual field during resection of intradural pathologies.

OBJECTIVE: A major challenge of a minimally invasive spinal approach (MIS) is maintaining freedom of maneuverability through small operative corridors. Unfortunately, during tubular resection of intradural pathologies, the durotomy and its accompanying tenting sutures offer a smaller operating window than the maximum surface of the tube's base. The objective of this study was to evaluate if a novel double tubular technique could expand the surgical visual field during MIS resection of intradural pathologies. METHODS: A total of 25 MIS resections of intradural extramedullary pathologies were included. A posterior tubular interlaminar fenestration was performed in all surgeries. A durotomy covering the whole diameter of the tubular base was the standard in all cases. After placement of two tenting sutures on each side of the durotomy and application of tension, the resulting surface of the achieved dura fenestration was measured after optical analysis of the intraoperative video. In the next step, a second tube, 2 mm thinner than and the same length as the first, was inserted telescopically into the first tube, resulting an angulated fulcrum effect on the tenting sutures. RESULTS: Optical surface analysis of the dura fenestration before and after the second tubular insertion verified a significant widening of the visual field of 43.1% (mean 18.84 mm2, 95% CI 16.8-20.8, p value < 0.001). There were no ruptured tenting sutures through the increased tension. Postoperative MRIs verified complete resection of the pathologies. CONCLUSIONS: Inserting a second tube telescopically during posterior minimally invasive tubular spinal intradural surgery leads to an angulated fulcrum effect on the dura tenting sutures which consequently increases the surface of the dura fenestration and induces a meaningful widening of the visual field.

Autologous platelet-rich fibrin (PRF) augmentation as an add-on therapy in deep surgical site infections (dSSIs) after instrumented spinal surgery: preliminary results of a single institution case series.

BACKGROUND: Deep surgical site infections (dSSIs) after instrumented spinal surgery pose major therapeutic challenges. Standard treatment involves surgical debridement, wound drainage, and long-term antibiotic administration. Autologous platelet-rich fibrin (PRF) constitutes a biomaterial obtained from patients' own blood that contains leukocytes, chemokines and growth factors boosting cicatrization. Due to favorable results reported from other surgical disciplines such as dentistry, orthopedics, maxillofacial and plastic surgery using PRF, the authors hypothesized that PRF augmentation will promote wound healing in dSSIs. OBJECTIVE: To report our preliminary results on the safety and efficacy of autologous-PRF as an add-on therapy on a pilot case series of persistent dSSI after instrumented spinal surgery. METHODS: Among the 293 patients who underwent dorsal decompression and stabilization of the cervical, thoracic, and lumbar spine due to degenerative diseases in our department, 12 patients (4%) presented persisting dSSI after standard wound debridement and antibiotic treatment. PRF augmentation was used during a second surgical revision as an add-on therapy to standard debridement. In all cases, the wound was primarily closed without drains. RESULTS: Wound healing was completed between 14 and 21 days after the second surgical revision in all patients. At a median follow-up of 8 months (range: 6 to 18 months), no recurrence of dSSI nor complications were encountered in any case. CONCLUSIONS: Our preliminary results suggest that PRF augmentation in persistent dSSI after instrumented spinal surgery appears to be a safe and effective strategy to promote wound healing. Prospective controlled studies are required to define the efficiency of PRF more clearly in both treating and preventing dSSI.