Minimally Invasive Spinal Surgery - Through a Straw

Researchers at the New York-Presbyterian Hospital/Weill Cornell Medical Center (NYP, New York, NY, USA) conducted a retrospective and prospective analysis of 230 patients who underwent non-instrumented minimally invasive 1- and 2-level lumbar microscope-assisted discectomies and laminectomies for degenerative lumbar spinal disease between 2004 and 2007. Patient demographic characteristics and operative results, length of stay, blood loss, operative times, and surgical complications were collected. Clinical outcomes were assessed based on pre- and postoperative visual analog scale scores, Oswestry Disability Index (ODI) values, and the Macnab outcome scale scores.

The study results showed characteristic differences in blood loss and operating times between 1- and 2-level procedures and between discectomies and laminectomies; the minimally invasive option helped to shorten a patient's length of stay, and reduced blood loss, operative times, and surgical complications. The researchers also noted that time in the operating room (OR) dropped significantly during the five-year study period, demonstrating a positive learning curve for surgeons performing the procedure. Major complications were not observed. The study was published in the September 2008 issue of the journal Neurosurgery Focus.

"The use of tubular retractors for microsurgical decompression of degenerative spinal disease is a safe and effective treatment modality,” concluded lead author Roger Härtl, M.D., chief of spinal surgery at NYP, and colleagues at the department of neurological surgery. "As with other techniques, minimally invasive procedures are associated with a significant learning curve. As surgeons become more comfortable with the procedure, its applications can be expanded to include, for example, spinal instrumentation and deformity correction.”

Microendoscopic discectomy (MED) is characterized by the use of a tubular retractor system and unique visualization through the oblique lens of an endoscope. The tubular retractor system allows reduced tissue or muscle trauma, and the oblique endoscope can provide a clear and wide visualization of the operative field beyond the confines of the tubular retractor. However, there is a steep learning curve associated with using the endoscopic operation system efficiently and safety.

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New York-Presbyterian Hospital/Weill Cornell Medical Center