The Orthopedic clinics of North America
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Orthop. Clin. North Am. · Jul 2007
ReviewVideo-assisted techniques in the management of thoracolumbar fractures.
The thoracolumbar junction is the most common region of the spine to be affected by injuries. Acute instability with structural damage to the anterior load-bearing spinal column and posttraumatic deformity represent the most frequent indications for surgery. A standardized operating technique with instruments and implants specially developed for the endoscopic procedure, ranging from an angled, stable plate and screw implant to endoscopically implantable vertebral body replacements, have gradually opened up the entire spectrum of anterior spine surgery to endoscopic techniques at the thoracolumbar junction.
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Orthop. Clin. North Am. · Jul 2007
ReviewTechniques for the operative management of thoracic disc herniation: minimally invasive thoracic microdiscectomy.
Thoracic disc herniations are uncommon lesions that are asymptomatic in most patients; however, for individuals who present with persistent radiculopathy that is nonresponsive to conservative treatment or with myelopathic symptoms with or without radiculopathy attributed to a thoracic disc herniation, operative intervention of the thoracic spine is sought. Various procedures and approaches for the treatment of thoracic disc herniations have been reported, but they have been associated with numerous intraoperative complications and postoperative morbidities. This article discusses a novel minimally invasive procedure for the surgical treatment of thoracic disc herniations referred to as a minimally invasive thoracic microdiscectomy. It uses a series of muscle dilators, a tubular retractor, and microscopic visualization by way of a posterolateral approach in an effort to minimize many of the complications that are associated with the more traditional approaches.
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Orthop. Clin. North Am. · Jul 2007
ReviewMinimally invasive techniques for the management of lumbar disc herniation.
Traditionally, minimally invasive techniques for surgical discectomy have been defined as smaller incisions, tubular retractors, microscopically assisted tissue dissection, and conservative removal of only extruded or sequestered nucleus pulposus with preservation of the annulus. The first truly minimally invasive technique was chymopapain dissolution of the nucleus pulposus. Other percutaneous techniques followed; however, none were as efficacious as the gold standard of microlumbar discectomy until endoscopically visualized methods evolved to allow visualized mechanical discectomy through the foramen. In experienced hands, such a technique is as effective as microlumbar discectomy and results in less surgical morbidity for herniations that are appropriate for this minimally invasive endoscopic surgical portal that completely avoids traumatizing the normal anatomy of the dorsal musculature and ligamentous structures.
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Orthop. Clin. North Am. · Jul 2007
ReviewMinimally invasive operative management for lumbar spinal stenosis: overview of early and long-term outcomes.
Standard open posterior decompression is well established and familiar to virtually all spine surgeons. However, this traditional surgical treatment of lumbar spinal stenosis (LSS) is often associated with significant postoperative pain, disability, and dysfunction. ⋯ This technique has been shown to provide symptomatic relief equivalent to that of open discectomy, with significant reductions in operative blood loss, postoperative pain, hospital stay, and narcotic usage. Furthermore, the article explains the rationale, indications, and surgical techniques for minimally-invasive LSS surgery and presents the authors' 4-year outcomes data.
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Orthop. Clin. North Am. · Jul 2007
Historical ArticleMinimally invasive spine surgery: a historical perspective.
Minimally invasive spine surgery has gained considerable momentum and increased acceptance among spine surgeons throughout the years. An understanding and awareness of the development of minimally invasive spine surgery and its role in the operative treatment of various spine conditions is imperative. This article provides a succinct historical perspective of the development of spine surgery from the more traditional, open procedures to the use of more "minimal access" or minimally invasive spine surgery procedures.