Thoracoscopy is a technique used to treat disc herniation, trauma, infection and tumours. The Sextant, a percutaneous fixation system was first used in November 2003 and showed burst fractures with no neurological signs in Polytrauma patients, good fixation in emergency, easy nursing and less bleeding.
There are two technical issues to do MIS. One is to place tubes in front of your target -the spine- and the second is to be able to put implants in the pedicles so if you master how to access the spine and how to go through the pedicles that’s it and all the tubes you have around MIS are tools and your surgical strategy in your mind will not change. Your indication is the same, your objective is the same,” said Court.
“I do believe this is a muscle sparing technology. It gives better comfort to our patients post-op. It has to be same objective as open surgery. At least in France MIS is a trend. Each year with new tools we think we are reaching perfection but every year there is something new and we are never reaching it,” he concluded.
Minimally invasive surgery provides adequate exposure and visualisation and has the same objectives as open surgery with long term results. Court advised starting with simple cases and not forgetting limitations such as reduction capabilities, bone grafting and decompression.
MIS offers post-op comfort in patients
Minimally invasive surgery is good for muscle preservation and post-operative comfort of patients said F.C. Öner, The Netherlands at the Medtronic Lunch Workshop at Eurospine.
Technical issues with spine accesses included tubular retractors, placement, dexterity and conversion and for pedicle catheterism included pedicle implants and vertebral augmentation.
Öner looked at “Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases”, a study by Fan Shunwu et al which discovered that minimally invasive transforaminal lumbar interbody fusion (TLIF) as a management of level one degenerative lumbar diseases is superior to the traditional open procedure in terms of postoperative back pain, total blood loss, need for transfusion, time to ambulation, length of hospital stay, soft-tissue injury, and functional recovery. However, this procedure takes longer operative duration and requires close attention to the risk of technical complications. Longer-term studies involving a larger sample are needed to validate the long-term efficacy of minimally TLIF.