Biomedical subjects
Publications and source records attributed to Mick J Perez-Cruet.
Posterior cervical microendoscopic foraminotomy and discectomy is an effective minimally invasive approach to cervical radiculopathy caused by foraminal osteophytes or lateral disc herniations. This article reviews the technique in detail as well as the advantages over open approaches. Nuances of the technique, including complications and their management, are also explored.
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.
OBJECTIVE: The objective of this review article is to describe the authors' operative technique for performing anterior cervical corpectomy and fusion. METHODS: The authors reviewed their operative technique and experience to clearly detail the general methods utilized to safely and effectively perform anterior cervical corpectomy and fusion. Specific nuances peculiar to the authors' technique were identified and highlighted. RESULTS: The operative technique for anterior cervical corpectomy, including nuances for enhancing ease or outcome of surgery, is described in detail. Drawings and photographs are included where appropriate to highlight specific aspects of the procedural technique. CONCLUSION: Anterior cervical corpectomy and fusion is a well known technique that proceeds in a consistent and logical sequence of maneuvers. Specific technical nuances at various points enhance the ease and safety of the technique, as well as the completeness of the eventual result.
OBJECT: Various approaches exist for the treatment of thoracic disc herniation. Anterior approaches facilitate ventral exposure but place the intrathoracic contents at risk. Posterolateral approaches require extensive muscle dissection that adds to the risk of postoperative morbidity. The authors have developed a novel posterolateral, minimally invasive thoracic microendoscopic discectomy (TMED) technique that provides an approach to the thoracic spine which is associated with less morbidity. METHODS: Seven patients 23 to 54 years old with nine disc herniations underwent TMED. All lesions were soft lateral or midline thoracic disc herniations. Under fluoroscopic guidance with the patient positioned prone, the authors used a muscle dilation approach and the procedure was performed with endoscopic visualization through a tubular retractor. Based on a modified Prolo Scale, five patients experienced excellent results, one good, and one fair. No case required conversion to an open procedure. The mean operative time was 1.7 hours per level, and estimated blood loss was 111 ml per level. Hospital stays were short, and no complications occurred. CONCLUSIONS: The TMED is safe, effective, and provides a minimally invasive posterolateral alternative for treatment of thoracic disc herniation without the morbidity associated with traditional approaches.
Complications of minimally invasive spinal surgery can be related to anesthesia, patient positioning, and surgical technique. The performance of successful minimally invasive spinal surgery is beset with several technical challenges, including the limited tactile feedback, two-dimensional video image quality of three-dimensional anatomy, and the manual dexterity needed to manipulate instruments through small working channels, which all account for a very steep learning curve. Knowledge of possible complications associated with particular minimally invasive spinal procedures can aid in their avoidance. This article reviews complications associated with minimally invasive spinal surgery in the cervical, thoracic, and lumbar spine by reviewing reported data of sufficient detail or with sufficient numbers of patients. In addition, possible complications associated with anesthesia use, patient positioning, and surgical techniques during thoracoscopic and laparoscopic spinal procedures are reviewed.
OBJECTIVE: The microendoscopic discectomy (MED) technique was initially developed in 1997 to treat herniated lumbar disc disease. Since then, thousands of cases have been successfully performed at more than 500 institutions. This article discusses the technical aspects of this procedure and presents a consecutive case series. METHODS: A total of 150 consecutive patients underwent MED. MED is performed by a muscle-splitting approach using a series of tubular dilators with consecutively increasing diameters. A tubular retractor is then inserted over the final dilator, and a specially designed endoscope is placed inside the tubular retractor. The microdiscectomy is performed endoscopically while the surgeon views the procedure on a video monitor. RESULTS: Clinical outcomes were determined using a modified MacNab criteria, which revealed that 77% of patients had excellent, 17% had good, 3% had fair, and 3% had poor outcomes. The average hospital stay was 7.7 hours. The average return to work period was 17 days. Complications primarily included dural tears, which occurred in 8 patients (5%) and were seen early on in the patient series. Complication rates diminished as the surgeon's experience with this technique increased. CONCLUSION: MED for lumbar herniated disc disease can be performed safely and effectively, resulting in a shortened hospital stay and faster return to work; however, there is a learning curve to this procedure.