Over the past few decades, interest in minimally invasive spine surgery (MISS) has increased tremendously due to its core principle of minimizing approach-related injury while providing outcomes similar to traditional open spine procedures. With technical and technological advancements, MISS has expanded its utility not only to simple spinal stenosis, but also to complex spinal pathologies such as metastasis, trauma, or adult spinal deformity. In this article, we review the techniques and technology in MISS and discuss the indications, benefits, and limitations of MISS.

BACKGROUND AND PURPOSE: Preexisting cognitive impairment is the strongest risk factor for delirium. We performed a pilot study to investigate whether the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), which is a good complement to direct cognitive testing, could be useful for predicting postoperative delirium in elderly patients. METHODS: Between June 2013 and May 2014, 37 patients aged 70 years or older underwent the Korean version of the Mini-Mental State Examination (K-MMSE) and completed the IQCODE (IQCODE-K) before elective spine surgery in the Spine Center at the Seoul National University Bundang Hospital. Delirium was assessed daily from the day after surgery until discharge. A Mann-Whitney U test was used to compare the K-MMSE scores and the IQCODE-K scores between the groups with and without postoperative delirium. RESULTS: A total of three of 37 (8.1%) patients developed delirium during their hospital stay. The K-MMSE scores were not different between the two groups (p=0.105), whereas the IQCODE-K scores of patients with delirium were significantly higher than those of patients without delirium (p=0.021), indicating greater cognitive and functional decline over the previous 10 years. CONCLUSION: The IQCODE may be a suitable tool for assessing preoperative cognitive function and predicting postoperative delirium in elderly patients.
Aged* ; Cognition ; Complement System Proteins ; Delirium* ; Humans ; Length of Stay ; Pilot Projects* ; Risk Factors ; Seoul ; Spine

BACKGROUND: Vitamin C has critical features relavant to postoperative pain management and functional improvement; however, no study has yet evaluated the effectiveness of vitamin C on improving the surgical outcomes for spine pathologies. Thus, this study aimed to explore the impact of vitamin C on postoperative outcomes after single-level posterior lumbar interbody fusion (PLIF) for lumbar spinal stenosis in prospectively randomized design. We conducted a 1-year prospective, randomized, placebo-controlled, double-blind study to evaluate the impact of vitamin C on the postoperative outcomes after PLIF surgery. METHODS: A total of 123 eligible patients were randomly assigned to either group A (62 patients with vitamin C) or group B (61 patients with placebo). Patient follow-up was continued for at least 1 year after surgery. The primary outcome measure was pain intensity in the lower back using a visual analogue scale. The secondary outcome measures were: (1) the clinical outcome assessed using the Oswestry Disability Index (ODI); (2) the fusion rate assessed using dynamic radiographs and computed tomography scans; and (3) complications. RESULTS: Pain intensity in the lower back was significantly improved in both groups compared with preoperative pain intensity, but no significant difference was observed between the 2 groups over the follow-up period. The ODI score of group A at the third postoperative month was significantly higher than the score of group B. After the sixth postoperative month, the ODI score of group A was slightly higher than the score of group B; however, this difference was not significant. The fusion rates at 1 year after surgery and the complication rates were not significantly different between the 2 groups. CONCLUSIONS: Postoperative pain intensity, the primary outcome measure, was not significantly different at 1 year after surgery between the 2 groups. However, vitamin C may be associated with improving functional status after PLIF surgery, especially during the first 3 postoperative months.
Ascorbic Acid* ; Double-Blind Method ; Follow-Up Studies ; Humans ; Outcome Assessment (Health Care) ; Pain, Postoperative ; Pathology ; Prospective Studies ; Spinal Stenosis ; Spine ; Treatment Outcome ; Vitamins*

OBJECTIVES: To present the latest knowledge on spine surgery using augmented reality (AR).SUMMARY OF LITERATURE REVIEW: AR is a new technology that simulates interactions with real-world surroundings using computer graphics, and it is a field that has recently been highlighted as part of the fourth industrial revolution. MATERIALS AND METHODS: Review of related literature and introduction of latest research. RESULTS: Spine surgery using AR is currently in its early stages. If industry, academia, and research institutes cooperate and develop, spine surgery using AR is highly likely to develop to the next level. CONCLUSIONS Spine surgeons should strive to develop relevant technology.

STUDY DESIGN: Review article. OBJECTIVES: To present the latest knowledge on spine surgery using augmented reality (AR). SUMMARY OF LITERATURE REVIEW: AR is a new technology that simulates interactions with real-world surroundings using computer graphics, and it is a field that has recently been highlighted as part of the fourth industrial revolution. MATERIALS AND METHODS: Review of related literature and introduction of latest research. RESULTS: Spine surgery using AR is currently in its early stages. If industry, academia, and research institutes cooperate and develop, spine surgery using AR is highly likely to develop to the next level. CONCLUSIONS: Spine surgeons should strive to develop relevant technology.
Academies and Institutes ; Computer Graphics ; Spine ; Surgeons

Minimally invasive spine surgery (MISS) has revolutionized the treatment of spinal disorders over the past few decades. This review provides an in-depth analysis of MISS techniques, technologies, outcomes, and future directions. The evolution of MISS techniques–including tubular retractor systems, percutaneous pedicle screw fixation, minimally invasive transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, and endoscopic spine surgery–has expanded the scope of treatable spinal pathologies while minimizing tissue trauma. Technological advancements such as intraoperative navigation, robotics, and augmented reality applications have enhanced precision and capabilities. Clinical evidence supports the efficacy and safety of MISS techniques for various spinal pathologies, demonstrating comparable or superior outcomes to traditional open approaches with reduced tissue trauma, blood loss, and hospital stays. Cost-effectiveness analyses also favor MISS over open techniques. Future directions in MISS include expanding indications, integrating artificial intelligence and machine learning, advancing tissue engineering and biologics, and refining robotic and augmented reality applications. As MISS continues to evolve, it is poised to play an increasingly important role in the treatment of spinal disorders, offering improved patient outcomes with reduced morbidity. However, ongoing rigorous evaluation of new techniques and technologies is crucial to balance potential benefits with associated risks and costs.

Minimally invasive spine surgery (MISS) has revolutionized the treatment of spinal disorders over the past few decades. This review provides an in-depth analysis of MISS techniques, technologies, outcomes, and future directions. The evolution of MISS techniques–including tubular retractor systems, percutaneous pedicle screw fixation, minimally invasive transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, and endoscopic spine surgery–has expanded the scope of treatable spinal pathologies while minimizing tissue trauma. Technological advancements such as intraoperative navigation, robotics, and augmented reality applications have enhanced precision and capabilities. Clinical evidence supports the efficacy and safety of MISS techniques for various spinal pathologies, demonstrating comparable or superior outcomes to traditional open approaches with reduced tissue trauma, blood loss, and hospital stays. Cost-effectiveness analyses also favor MISS over open techniques. Future directions in MISS include expanding indications, integrating artificial intelligence and machine learning, advancing tissue engineering and biologics, and refining robotic and augmented reality applications. As MISS continues to evolve, it is poised to play an increasingly important role in the treatment of spinal disorders, offering improved patient outcomes with reduced morbidity. However, ongoing rigorous evaluation of new techniques and technologies is crucial to balance potential benefits with associated risks and costs.

Minimally invasive spine surgery (MISS) has revolutionized the treatment of spinal disorders over the past few decades. This review provides an in-depth analysis of MISS techniques, technologies, outcomes, and future directions. The evolution of MISS techniques–including tubular retractor systems, percutaneous pedicle screw fixation, minimally invasive transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, and endoscopic spine surgery–has expanded the scope of treatable spinal pathologies while minimizing tissue trauma. Technological advancements such as intraoperative navigation, robotics, and augmented reality applications have enhanced precision and capabilities. Clinical evidence supports the efficacy and safety of MISS techniques for various spinal pathologies, demonstrating comparable or superior outcomes to traditional open approaches with reduced tissue trauma, blood loss, and hospital stays. Cost-effectiveness analyses also favor MISS over open techniques. Future directions in MISS include expanding indications, integrating artificial intelligence and machine learning, advancing tissue engineering and biologics, and refining robotic and augmented reality applications. As MISS continues to evolve, it is poised to play an increasingly important role in the treatment of spinal disorders, offering improved patient outcomes with reduced morbidity. However, ongoing rigorous evaluation of new techniques and technologies is crucial to balance potential benefits with associated risks and costs.

Minimally invasive spine surgery (MISS) has revolutionized the treatment of spinal disorders over the past few decades. This review provides an in-depth analysis of MISS techniques, technologies, outcomes, and future directions. The evolution of MISS techniques–including tubular retractor systems, percutaneous pedicle screw fixation, minimally invasive transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, and endoscopic spine surgery–has expanded the scope of treatable spinal pathologies while minimizing tissue trauma. Technological advancements such as intraoperative navigation, robotics, and augmented reality applications have enhanced precision and capabilities. Clinical evidence supports the efficacy and safety of MISS techniques for various spinal pathologies, demonstrating comparable or superior outcomes to traditional open approaches with reduced tissue trauma, blood loss, and hospital stays. Cost-effectiveness analyses also favor MISS over open techniques. Future directions in MISS include expanding indications, integrating artificial intelligence and machine learning, advancing tissue engineering and biologics, and refining robotic and augmented reality applications. As MISS continues to evolve, it is poised to play an increasingly important role in the treatment of spinal disorders, offering improved patient outcomes with reduced morbidity. However, ongoing rigorous evaluation of new techniques and technologies is crucial to balance potential benefits with associated risks and costs.

STUDY DESIGN: A cross-sectional, case-control study. PURPOSE: To investigate associations between physical fitness measures and disabilities related to back pain and quality of life (QOL) by the presence of symptomatic lumbar spinal stenosis (LSS) in elderly Korean women. OVERVIEW OF LITERATURE: LSS leads to decreased functioning and reduced QOL. However, correlations among physical fitness, disability, and QOL have not been investigated in elderly women with LSS. METHODS: Participants included women aged 65 years and older (n=192), divided into a study group (n=38) and a control group (n=154) based on the presence/absence of LSS. All participants underwent physical function and fitness tests. Oswestry disability index (ODI) scores and EuroQol five-dimensional questionnaire (EQ-5D-5L) scores were used to assess disability and health-related QOL. RESULTS: The results for the handgrip strength, sit-and-reach, functional reach, and timed up and go (TUG) tests were significantly higher in the control group than the LSS group. ODI scores were significantly higher and EQ-5D-5L scores significantly lower in the LSS group. TUG and functional reach test scores were significantly correlated with ODI scores, and handgrip strength was strongly interrelated with ODI and EQ-5D-5L scores in the LSS group. No other physical fitness measures showed statistically significant relationships with ODI or EQ-5D-5L scores. CONCLUSIONS: In elderly Korean women with LSS, back pain-related disability and QOL are significantly associated with some physical fitness parameters such as handgrip strength. Handgrip strength reflects general muscle strength, which is significantly interrelated with the level of disability and QOL. Our results suggest that enhancing generalized muscle strength helps to reduce disability due to back pain and improve QOL in patients with LSS.
Aged* ; Back Pain ; Case-Control Studies ; Female ; Humans ; Lumbar Vertebrae ; Muscle Strength ; Physical Fitness* ; Quality of Life* ; Spinal Stenosis*