Neurosurgery clinics of North America
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The modern era of minimally invasive spine surgery has its roots in percutaneous techniques developed in the mid-twentieth century. The widespread application of minimally invasive techniques seen today is predicated on technologic developments of only the past 10 years, however. This article reviews the development of minimally invasive spinal surgery as it has evolved for the cervical, thoracic, and lumbar spine. Each new development has sought to equal or improve on the effectiveness demonstrated by comparable open surgical techniques while reducing iatrogenic tissue trauma and resultant postoperative pain and disability, to produce overall better outcomes for patients.
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Thoracic microendoscopic discectomy is a safe effective treatment for surgical removal of herniated thoracic intervertebral discs. This approach allows access through a minimally invasive muscle-splitting posterolateral approach that does not place the contents of the thoracic cavity at risk. In the lumbar spine, this approach has been proven effective, with a shorter length of hospital stay, less postoperative pain, decreased blood loss, and shorter recovery time. These same advantages can be expected in the thoracic spine with appropriate patient selection and proper surgical technique.
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Neurosurg. Clin. N. Am. · Oct 2006
ReviewMinimally invasive approaches to vertebral column and spinal cord tumors.
Minimally invasive approaches to spinal tumors have evolved rapidly over the past 15 to 20 years as clinicians seek to avoid the morbidity and long-term dysfunction associated with traditional open surgical procedures. We review the noninvasive, percutaneous, and minimally invasive surgical techniques currently available for the treatment of spinal column and intradural spinal tumors, including minimal access thoracic corpectomy and minimal access intradural tumor surgery. The various advantages and limitations of these approaches as well as their appropriate indications and uses are also presented here. A measured understanding of surgical objectives and iatrogenic effects on patients' quality of life allows the surgeon to implement such minimally invasive approaches in the design of individualized treatment plans that range from pure palliation to definitive cure.