Drawn from the MedMarket Diligence report, "Spine Surgery: Products, Technologies, Markets & Opportunities, Worldwide, 2008-2017."
A traditional, “open” surgical spine procedure typically involves the surgeon making a long incision, from either an anterior or posterior approach, dissecting and retracting layers of tissue as needed to provide both visualization and access to the affected area. For many kinds of operations—instrumented spinal fusion the most notable—open procedures remain the norm due to the demands of positioning, attaching, and configuring fixation devices. A higher rate of patient postoperative complications and a longer recuperative time period are thought to result from many open procedures, however. These findings have helped to drive the development of minimally invasive techniques—and instrumentation—for certain kinds of operations; in the near future, new minimally invasive technologies and techniques will likely change the approach to operations currently performed with traditional means.
Traditional "Open" Spine Surgery Procedures
|
Name of Procedure
|
Clinical Indications to Perform Procedure
|
|
Anterior Cervical Discectomy and Fusion (ACDF)
|
An intervertebral disc in the cervical spine bulges or herniates, exerting pressure on an adjacent nerve root. Procedure also used to remove tumors, osteophytes, or vertebral fracture fragments from the spinal canal.
|
|
Anterior Lumbar Interbody Fusion (ALIF)
|
Herniated intervertebral disc in the lumbar spine.
|
|
Cervical Corpectomy
|
Narrowing of the cervical spinal canal due to growth of bone spurs or the ligament behind the vertebral bodies, where an anterior cervical discectomy does not address the entire area of neural compression.
|
|
Cervical Foraminotomy
|
Space through which a spinal nerve root branches off from the cervical spinal canal is too narrow, exerting pressure on the root
|
|
Cervical Laminoplasty
|
Cervical spinal canal is painfully restrictive due to injury or disease.
|
|
Decompressive Lumbar Laminectomy
|
Abnormal bone spurs or rough intervertebral disc edges exert pressure on spinal nerve roots or the cauda equina, a nerve root bundle at the end of the spinal cord.
|
|
Interbody Fusion with Cages
|
Performed to remove a damaged intervertebral disc and fuse the vertebrae above and below the disc space.
|
|
Posterior Lumbar Interbody Fusion (PLIF)
|
Herniated intervertebral disc in the lumbar spine.
|
|
Spinal Fusion
|
Indicated in a variety of instances to unite two or more bony segments so that they grow together
|
|
Posterolateral Gutter Spine Fusion
|
Indicated in a variety of instances to unite two or more bony segments so that they grow together. This approach has a high level of success due to the rich vascular network present in the posterolateral spinal region.
|
|
Transforaminal Lumbar Interbody Fusion (TLIF)
|
Performed to remove a damaged intervertebral disc and fuse the vertebrae above and below the disc space.
|
Source: MedMarket Diligence, report #M510
Minimally Invasive Procedures
While patient concerns remain a significant driver in the development of minimally invasive techniques, technological advances in surgical instrumentation have transformed the theoretical to the practical. Advanced fluoroscopy, or x-ray imaging during surgery, has markedly improved the accuracy of incisions made and hardware placed. A variety of endoscopes, camera-tipped wands, can be inserted through small incisions and provide the surgeon with excellent visualization of the operative site. New surgical instruments were developed to work in tandem with endoscopes. The past several years have brought numerous innovations to spine surgery. These innovations include the development of imaging systems that interpret anatomical data for three-dimensional display; the use of lasers, ultrasonic frequencies, and high-pressure water jets remove tissue; and new monitoring devices that help the surgeon to optimally position instrumentation as well as to warn of potentially damaging neural contact during a procedure. Spine operations that lend themselves particularly well to minimally invasive approaches are intervertebral disc decompressions and discectomies. Progress has been made in adapting certain kinds of spinal fusion procedures to a minimally invasive approach, and certain forms of scoliosis of the thoracic spine have been treated with minimally invasive surgery.
MIS has many enthusiastic supporters. However, caution needs to be exercised, as even though a technique is less traumatic, if the rate of successful spinal fusion is much lower, then there is really not an advantage. Also, it has yet to be demonstrated that minimally invasive spine fusion systems actually cause better outcomes than some other surgical techniques used in the traditional open approach.
Increasingly, minimally invasive techniques are becoming the preferred method for autologous bone graft procedures. Traditional procedures involve the surgeon making a 3- to 5-inch incision to harvest bone from the patient’s hip area, and some studies have shown that complications arise in nearly a third (31%) of these patients. These studies also show that about 27% of patients still feel pain in the hip area up to two years after the surgery.
Minimally Invasive Spine Surgery Procedures
|
Name of Procedure
|
Goal of Procedure
|
|
Vertebroplasty
|
Performed to treat fractured or collapsed vertebra
|
|
Kyphoplasty
|
Performed to lessen or eliminate pain due to an osteoporotic compression fracture of the vertebra
|
|
Microscopic Discectomy
|
Performed to relieve pressure on spinal nerve roots caused by a ruptured intervertebral disc
|
|
Disc Decompression
|
Performed to remove extruded portions of an uncontained herniated disc or to remove nuclear disc material causing a bulge in a contained herniation. Decompressing the disc relieves pressure on adjacent nerve roots.
|
|
Endoscopic Scoliosis Surgery
|
Performed to correct abnormal lateral curvature; this is an alternate procedure for certain forms of scoliosis appearing in the thoracic spine
|
Source: MedMarket Diligence, report #M510
Comments 1
Quite a good information. I have been surfing online for the prob I am suffering i.e. “Disk Herniation” and got here. For this problem contacted shoulderkneeorthopedics and they have diagnosed the issue and helped me cure faster.
Posted 10 Mar 2010 at 5:43 pm ¶Post a Comment