The symposium titled “Minimally invasive spine surgery: simple to complex applications” was introduced by William Mitchell, North American Spine Society representative to the CPT Advisory Committee at the 2010 annual meeting.
Adoption hampered by radiation
The adoption of minimally invasive surgery is hampered by radiation, Choll W Kim, Spine Institute of San Diego, California told delegates while discussing image guidance for minimally invasive spine surgery.
“There is now less blood loss, improved extension strength, shorter hospital stay and less wound infection,” stated Kim, adding that, “all surgical techniques evolve to become less invasive.”
According to the National Council on Radiation Protection and Measurements (NCRP), “extrapolation of risks from exposures at high doses, in addition to inherent experimental errors in the data, is most likely that predominant uncertainty in the estimate of risk at low doses”.
Complications in minimally invasive spine surgery unavoidable
Complication rates in minimally invasive surgery are lower than standard surgery, but they do occur. The findings were presented by Robert E Isaacs, Duke University Medical Center, North Carolina.
Isaacs insisted that pre-operative planning, patient selection and looking at pre-operative studies, was essential and advised on the importance of positioning where surgeons need to be able to image the patient, understand the X-rays and watch the fluoroscopy time. He also noted that some complications such as infection, bleeding, cerebrospinal fluid leak and deep vein thrombosis/pulmonary embolism were mostly unavoidable. There were a total of 228 open and 238 MIS cases across seven studies. Open surgery average operating room time was 203 minutes, estimated blood loss 626ml, length of stay 8.1 days.
Five patients contracted infection and 12 patients had a cerebrospinal fluid leak. Minimally invasive surgery average operating room time was 215 minutes, estimated blood loss 241ml, length of stay 5.6 days. Complications included infection (six patients) and cerebrospinal fluid leak (three patients).
Isaacs concluded that overall complication rates are dramatically lower than standard surgical techniques, agreed that complications do occur but advised learning safely, progressing slowly, concentrating on the basics and learning when not to do the procedure.