Post-traumatic Vertebral Compression Fracture Treated with Minimally Invasive Biologic Vertebral Augmentation for Reconstruction.

In the United States, there is a high incidence of motor vehicle and sports injuries among the active population causing symptomatic post-traumatic vertebral compression fracture. At our institution, 28 cases of painful post-traumatic vertebral compression fractures (PPT-VCFs) were successfully treated with percutaneous vertebral augmentation (VA) for stabilization and reconstruction with intravertebral polyethylene mesh sac (OptiMesh®, Spineology, Inc., Stillwater, MN) and biological morcelized bone graft. The surgical approach provides an efficacious and controlled minimally invasive delivery mechanism to stabilize and reconstruct VCFs, as well as avoiding serious complications from Polymethylmethacrylate (PMMA) of vertebroplasty and kyphoplasty. The construct for biological bone graft/vertebral augmentation is osteoconductive and osteoinductive, and is used to create biologic vertebral stabilization and reconstruction. The adjacent vertebra integrity is protected by the construct with similar elasticity and physical characteristics of the biologic morcelized bone, more matched to that of adjacent bone than PMMA. The surgical techniques are described herein.

Innovative grid positioning system (GPS) guidance for minimally invasive spinal surgery.

Symptomatic degenerated spinal discs and spinal stenosis are common problems that can often be treated conservatively, but some require decompressive spinal surgery for relief. Traditional open spinal discectomy is associated with significant tissue trauma, higher morbidity and complication rates, a longer convalescence, and even destabilization of the spine. The trend of spinal surgery is rapidly moving toward less traumatic minimally invasive spine surgery (MISS).1,2 The problem that faces the surgeon performing endoscopic MISS is that it is done with limited surgical exposure and visualization of the surgical field. The surgical field can only be viewed through an endoscope to correlate the lesion/pathology in relationship to imaging studies aided by C-arm fluoroscopy. In response, a logical and simple Grid Positioning System (GPS) was developed to provide a precise surgical trajectory/approach for the disc lesion to undergo decompression. GPS involves 3D geometric triangulation of 3 different planes guided by fluoroscopy for introduction of surgical instruments along a geometric line toward the lesion without compromising healthy anatomical structures. This system facilitates MISS, especially in the morbidly obese. In this chapter, we will describe the GPS system and its application to aid in facilitating minimally invasive decompressive spine surgery for alleviating symptoms of degenerative spinal disease, herniated disc, and spinal stenosis, while avoiding the complications and risks of conventional more traumatic spinal surgery and fusion.

Evolving minimally invasive spine surgery: a surgeon's perspective on technological convergence and digital or control system.

Degenerated spinal disc and spinal stenosis are common problems requiring decompressive spinal surgery. Traditional open spinal discectomy is associated with significant tissue trauma, greater morbidity/complications, scarring, often longer term of convalescence, and even destabilization of the spine. Therefore, the pursuit of less traumatic minimally invasive spine surgery (MISS) began. The trend of spinal surgery is rapidly moving toward MISS. MISS is a technologically dependent surgery, and requires increased utilization of advanced endoscopic surgical instruments, imaging-video technology, and tissue modulation technology for performing spinal surgery in a digital operating room (DOR). It requires seamless connectivity and control to perform the surgical procedures in a precise and orchestrated manner. A new integrated DOR, the technological convergence and control system SurgMatix(R), was created in response to the need and to facilitate MISS with "organized control instead of organized chaos" in the endoscopic OR suite. It facilitates the performance, training, and further development of MISS.

Endoscopic assisted microdecompression of cervical disc and foramen.

The anterior endoscopic cervical microdecompression (AECM) of disc and foramen with added application of nonablative lower holmium laser energy for disc shrinkage (laser thermodiskoplasty) has proven to be safe, less traumatic, easier, and more efficacious than conventional methods with significant economic savings. It preserves spinal motion and provides a channel for spinal arthroplasty. It is an effective alternative or replacement for conventional open cervical spinal surgery for discectomy, and can decompress spinal stenosis and degenerative spine conditions.

Endoscopic assisted lumbar microdecompressive spinal surgery with a new SMART endoscopic spine system.

In response to the rapid development and demand of outpatient endoscopic minimally invasive lumbar surgical technique, the SMART endoscopic spine system was developed for neurodecompression. This lumbar spine surgery is performed with a small skin incision, dilatation surgical technology, and an endoscopic-assisted spinal surgical system with progressive serial tubular retractors providing superior lighting and better visualization of the operative field for performing minimally invasive spinal surgery (MISS). The SMART system incorporates the advantages of posterior paramedian endoscopic assisted microdecompressive surgical spinal system and posterolateral endoscopic lumbar system. This versatile SMART endoscopic spine system with various sized working channels provides a generous and optimal access for endoscopic MISS of microdecompression of herniated lumbar disc, degenerative spinal disease, spinal stenosis, and removal of intraspinal lesions as well as creating an access for spinal arthroplasty and spinal fixation. With the unique features of the SMART system, the surgeon can take advantage of microscopic, endoscopic, or direct vision for microdecompressive spinal surgery, bridging endoscopic and conventional spinal surgery. It appears easy, safe, and efficacious. This less traumatic and easier outpatient MISS treatment leads to excellent result speedier recovery, and significant economic savings. The SMART endoscopic spine system, surgical indications, operative techniques, and the potential complications and their avoidance are described and discussed herein.

Interspinous process decompression (IPD) system (X-STOP) for the treatment of lumbar spinal stenosis.

With increased life expectancy and an aging population, many patients suffering from progressive lumbar spinal stenosis with symptomatic neurogenic intermittent claudication (NIC) have been limited to a choice between nonsurgical therapies or a more traumatic decompressive surgical procedure, with or without lumbar fusion. The interspinous process decompression (IPD) system, the X-STOP implant, was developed to provide a minimally invasive alternative therapeutic treatment of lumbar spinal stenosis. The X-STOP IPD system, surgical indications, operative techniques, and the potential complications and their avoidance are described and discussed herein.

Percutaneous vertebral augmentation and reconstruction with an intravertebral mesh and morcelized bone graft.

Percutaneous vertebral augmentation (VA) and reconstruction with intravertebral polyethylene mesh sac (OptiMesh) and morcelized bone graft provided a minimally invasive efficacious and controlled delivery mechanism to stabilize and treat painful osteoporotic, traumatic and neoplastic vertebral compression fractures (VCFs), as well as avoided serious complications from Polymethylmethacrylate (PMMA) of Vertebroplasty and Kyphoplasty. Osteoconductive and osteoinductive and can be used to create biologic vertebral reconstruction. The adjacent vertebra integrity should be more protected by the construct with a similar elasticity and physical characteristics of the morcelized bone, more matched to that of adjacent bone than PMMA. The indications and surgical techniques are described herein.

Junctional disc herniation syndrome in post spinal fusion treated with endoscopic spine surgery.

Fusions of the cervical and lumbar spine are often followed within months or several years by protrusion of discs at the adjacent level or levels. Biomechanical alterations and mobility lost at the fused levels are thought to be transferring the stress to the adjacent segments or discs, which results in accelerated degeneration of the discs and causes disc protrusion. This post-spinal fusion "junctional disc herniation syndrome" (JDHS), or the post-spinal fusion "adjacent segment disease (ASD)" can occur from 15% to 52% of post-spinal fusion, in both superior and/or inferior adjacent levels. The ways in which endoscopic minimally invasive spinal discectomy procedure can be used to treat this JDHS and preserve spinal segmental motion are discussed herein. Also, case illustrations are presented.

Evolving transforaminal endoscopic microdecompression for herniated lumbar discs and spinal stenosis.

The objective of this chapter was to demonstrate evolving transforaminal endoscopic microdecompression for herniated lumbar discs and spinal stenosis, and to become accomplished with endoscopic micro spinal instruments and laser application. Since 1993, 2000 patients with 3421 herniated lumbar discs were diagnosed with symptomatic lumbar single and multiple herniated intervertebral discs. Progressive series of different diameters endoscopic-assisted tubular retractors, with appropriate-sized dilators and more aggressive saw-toothed trephines, and laser were used to perform transforaminal endoscopic micro-decompression, in addition to the posterior-lateral foraminoscope and endoscopic-assisted spinal operating systems. No postoperative mortalities occurred, and the morbidity rate was less than 1%, in the 2000 patients. For a single level, 94% of the patients had good or excellent results; 6% had some residual symptoms although improved overall. Transforaminal endoscopic laser microdecompression can effectively decompress herniated lumbar discs and spinal stenosis, when foraminoplasty is performed, which provides a safe and effective modality to achieve results in effective spinal decompression, preserves spinal motion, and creates a channel for spinal arthroplasty.

Percutaneous microdecompressive endoscopic thoracic discectomy for herniated thoracic discs.

Spinal surgeons have long sought to find a procedure of choice by which to treat thoracic disc herniations. The threat of cord injury has stimulated many attempted approaches including posterior laminectomy (abandoned currently as too likely to result in neurologic loss), costotransversectomy, trans-thoracic trans-pleural, postero-lateral, trans-pedicular and, more recently, transthoracic endoscopic. Commonly, surgery is not contemplated unless significant cord compression and neurologic deficit is present.