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TECHNICAL ADVANCES IN MINIMALLY INVASIVE INTERBODY FUSION FOR THE TREATMENT OF LUMBAR RADICULOPATHY
Author(s) -
Mannion R. J.,
Nowitzke A. M.,
Wood M. J.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04924_1.x
Subject(s) - medicine , surgery , spondylolisthesis , percutaneous , degenerative disc disease , fluoroscopy , decompression , minimally invasive procedures , invasive surgery , lumbar , iliac crest , diskectomy , spinal stenosis , discectomy , lumbar vertebrae
Posterolateral pedicle screw fixation with interbody fusion is a popular technique to treat degenerative lumbar spine disease with radiculopathy, particularly in the presence of foramenal stenosis and/or lumbar spondylolisthesis. Recently, minimally invasive techniques have been developed with which to achieve the same surgical goals as open surgery, offering the patient the potential for less post‐operative pain and a quicker recovery. Methodology: 64 consecutive patients between 2005 & 2008 were treated with minimally invasive interbody fusion and percutaneous pedicle screw fixation with navigation (Stealth, Medtronic). Following removal of the disc contents, the interbody cage(s) were inserted with iliac crest bone graft +/− BCP in the first half of the series, and local bone graft and BMP in the latter half. Results: Our current technique includes a number of key changes which have evolved to overcome specific difficulties and as technology has advanced. We now perform the procedure using CT‐guided navigation for pedicle screw insertion and muscle splitting minimally invasive tube surgery for decompression and interbody fusion for all but a small number of cases at L5/S1 where the lumbosacral angle precludes access through a tube. A number of improvements have been introduced with regard to – radiation exposure; interbody fusion technique; navigation with fluoroscopy versus CT, and methods to encourage fusion including the use of BMP. Conclusions: Minimally invasive interbody fusion is an attractive alternative to open techniques, with less post‐operative pain and quicker recovery for the patient. The pros and cons of minimally invasive versus open techniques will be discussed.