Journal of Minimally Invasive Spine Surgery and Technique.2024;9(1):1-2. doi:10.21182/jmisst.2024.01333
Journal of Minimally Invasive Spine Surgery and Technique
2016 (1, 1) to Present ISSN: 2508-2043
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Journal of Minimally Invasive Spine Surgery and Technique.2024;9(1):69-73. doi:10.21182/jmisst.2023.00990
Traditional surgical techniques for extradural lumbar schwannomas are associated with considerable morbidity, including spinal instability and injury to the viscera and lumbar plexus. Minimally invasive approaches decrease soft tissue damage, blood loss, and postoperative length of stay. For select extraforaminal schwannomas, a minimally invasive lateral transpsoas approach affords a direct surgical corridor. A 53-year-old obese female presented with 1 year of left iliopsoas weakness and L3 radiculopathy refractory to conservative management. Lumbar spine magnetic resonance imaging revealed a contrast-enhancing mass within the left psoas muscle consistent with an extraforaminal L3 schwannoma. The patient underwent minimally invasive oblique retroperitoneal surgical resection. Intraoperatively, the nerve root was splayed over the superior-lateral portion of the tumor limiting us to subtotal resection with nerve root preservation. The patient had improvement of pain and weakness that persisted at a 3-month follow-up. A minimally invasive lateral/oblique transpsoas approach provides a direct surgical approach for extraforaminal schwannoma. Patient body habitus and the nerve root relationship to the tumor may present limitations for the safe extent of resection.
Journal of Minimally Invasive Spine Surgery and Technique.2024;9(1):74-79. doi:10.21182/jmisst.2023.01053
This report presents a rare case of a fungal infection following an anterior lateral interbody fusion (ALIF) procedure. A 73-year-old man with rheumatoid arthritis underwent ALIF for lumbar spondylolisthesis and spinal stenosis. After surgery, he experienced severe back pain. Radiological tests showed pseudoarthrosis, osteolysis, and signs of surgical site infection. Revision surgery using oblique lateral interbody fusion (OLIF) and an allo-bone graft was performed. This addressed the complications, removed the previous cage, and provided interbody support. The patient’s pain significantly decreased, and he recovered from an Aspergillus fumigatus infection after voriconazole treatment. Follow-up examinations confirmed the infection’s resolution and the maintenance of spinal stability. It is crucial to identify fungal infections in patients on immunosuppressive drugs. The case validates the efficacy of voriconazole efficacy in treating Aspergillus spondylitis and the safety and effectiveness of OLIF for ALIF revision surgery.
Uniportal Dual Mode Dry-Saline Endoscopy for Lumbar Disc Herniation
Journal of Minimally Invasive Spine Surgery and Technique.2024;9(1):14-23. doi:10.21182/jmisst.2023.01165
Objective:
Posterior dry medium endoscopic lumbar discectomy techniques have been successfully used to treat lumbar disc prolapse. A drawback of these techniques is repeated blood staining of the scope tip while working close to the surgical target. To address this drawback, we modified the design of the previous Arthrospine system and made it compatible for use in air and saline medium to treat lumbar, cervical, and thoracic disc prolapse. Herein, we describe the operative technique and results of lumbar discectomy in a dual (air/saline) medium using this system.
Methods:
Eighty patients underwent endoscopic discectomy using the Arthrospine Duo system for lumbar disc prolapse. The procedure was conducted through a muscle dilatation approach using 5-mm and 10-mm dilators. The Arthrospine Duo tube was passed over a 10-mm dilator, the working insert was adjusted over the tube in a press-fit manner, and endoscopic discectomy was performed using a 30° arthroscope and conventional microdiscectomy instruments in an air or saline medium.
Results:
As per the modified MacNab criteria, 80% (n=64) of patients had excellent, 12.5% (n=10) good, 6.25% (n=5) fair, and 1.25 patients (n=1) had poor results. The leg pain visual analogue scale improved from 7.87±0.68 to 1.3±0.67 at 2 years of follow-up. As complications, dural tears and transient paraesthesia occurred in 4 patients (5%) each, nerve root injury in 1 patient (1.25%), and superficial wound infection in 5 patients (6.25%).
Conclusion
The uniportal Arthrospine Duo system can be used in air/saline medium and is an excellent minimally invasive option for lumbar discectomy.
Surgical Options for Bertolotti Syndrome
Journal of Minimally Invasive Spine Surgery and Technique.2024;9(1):3-13. doi:10.21182/jmisst.2024.01242
This article provides a comprehensive examination of Bertolotti syndrome (BS), a disorder characterized by back pain due to a lumbosacral transitional vertebra, to facilitate surgical decision-making by exploring various surgical options, including the innovative approach of endoscopic spine surgery. A review of existing literature and studies on BS published until December 2023 was undertaken, utilizing databases such as PubMed and Google Scholar to identify relevant information. The review offers an integrated overview of the essential knowledge of BS and a comprehensive range of surgical treatments. Symptomatic BS can manifest as pain originating from pseudoarticulation and the facet joints, discs, adjacent segments, and the L5 root, indicating a diverse distribution of pain sources. Furthermore, various surgical strategies are tailored to the specific origin of pain, including pseudoarticulation resection, transverse processectomy, decompression, nerve root decompression, fusion, and endoscopic spine surgery. For individuals with BS contemplating surgical solutions, performing a detailed assessment of symptoms and physical evaluations is imperative to accurately identify the origin of the pain. The choice of a surgical strategy must be meticulously customized according to the identified source of pain, guaranteeing a tailored and efficacious treatment for each patient.
Journal of Minimally Invasive Spine Surgery and Technique.2024;9(1):24-30. doi:10.21182/jmisst.2023.01158
Objective:
Patients with radiculopathy after failed spine surgery due to restenosis, regenerated bony spurs, or inadequate decompression face high risks for morbidity or disability following massive revision operations. Therefore, fully endoscopic spine surgery could be less invasive, safer, and more effective because of accurate exposure, precise decompression, and avoidance of neural tissue injury. Our report aimed to describe the clinical result of selected patients with failed back surgery syndrome (FBSS) treated with fully endoscopic spine surgery at Saint Paul General Hospital in Vietnam.
Methods:
We retrospectively reviewed 24 patients with FBSS who were treated with uniportal fully endoscopic surgery at Saint Paul General Hospital with an average follow-up period of 16 months.
Results:
The patients’ average age was 61 years (range, 24–83 years), and the difference between preoperative and postoperative leg pain at the last follow-up was statistically significant (preoperative leg pain visual analogue scale [VAS]=7.1; last follow-up leg pain VAS=0.8; p<0.01). The difference in Oswestry Disability Index scores between the preoperative assessment and the final examination was statistically significant (preoperative, 57.8; last follow-up, 21.2; p<0.01). According to improvements in the MacNab score, the percentage of patients who achieved good or excellent postoperative results was 75%.
Conclusion
Major open surgery as a revisional procedure in patients with FBSS syndrome has many potential risks during and after surgery. Fully endoscopic spine surgery can be a safe and effective option for selected cases with lower risk.
Journal of Minimally Invasive Spine Surgery and Technique.2024;9(1):61-68. doi:10.21182/jmisst.2024.01172
Objective:
Fluoroscopy-guided percutaneous pedicle screw fixation (FGPSF) and its further development, robot-assisted percutaneous pedicle screw fixation (RAPSF), are minimally invasive spinal surgery (MISS) techniques. FGPSF is a standard technique at our hospital, and RAPSF incorporating artificial intelligence has been performed at our hospital since October 2021. This study compared these 2 techniques and analyzed their differences, accuracy, and clinical outcomes based on our experiences.
Methods:
This study conducted a detailed analysis of screw accuracy and the clinical outcomes of 2 MISS techniques, FGPSF, and RAPSF. Screw accuracy was evaluated using the Gertzbein and Robbins scale, categorizing placements into grades A–E, with grades A and B considered clinically acceptable. Accuracy was assessed using postoperative computed tomography images for FGPSF and intraoperative O-arm scan images for RAPSF. Clinical outcomes were compared by examining parameters, such as hospitalization duration, C-reactive protein (CRP) normalization period, estimated blood loss (EBL), and preoperative/postoperative visual analogue scale (VAS) scores. Screw-related complications were reviewed. Independent image evaluations by nonparticipating spine specialists ensured objective and reliable assessments.
Results:
Both FGPSF and RAPSF demonstrated high rates of clinically acceptable screw placement, with minimal breaches that required no repositioning. The clinically acceptable rates of FGPSF and RAPSF were similar (99.17% and 99.19%, respectively). Both groups also demonstrated similar clinical outcomes. The CRP normalization period, EBL, and ΔVAS (preoperative—postoperative) scores revealed no statistically significant differences between FGPSF and RAPSF. Neither group experienced screw-related complications; however, the RAPSF group exhibited a statistically significant shorter hospital stay than the FGPSF group.
Conclusion
This study compared the accuracy and clinical outcomes of FGPSF and RAPSF. Both methods demonstrated no significant differences in accuracy or clinical outcomes. Spine surgeons selected between the 2 methods based on individual patient needs, and additional research is required to fully understand the practical advantages of each technique in the clinical field.
Journal of Minimally Invasive Spine Surgery and Technique.2024;9(1):31-36. doi:10.21182/jmisst.2023.01137
Lumbar peritoneal shunt (LPS) is the standard treatment for nonobstructive hydrocephalus. Shunt infection, overdrainage, bleeding, and cerebrospinal fluid leaks have been reported as LPS complications. We present a 70-year-old man who developed iatrogenic spondylodiscitis 2 weeks after LPS placement, experiencing severe back pain and neurological deficits. Despite the empiric antibiotics, his symptoms persisted. The patient underwent fully endoscopic debridement and drainage (FEDD) to address the infection without LPS removal. After the procedure, the patient experienced a significant reduction in pain. Even though pathogen cultures were negative, the empiric antibiotic treatment continued for 6 full weeks. The patient was able to ambulate with a thoracolumbar orthosis due to the lumbar kyphotic deformity. FEDD, in conjunction with effective antibiotics, offers rapid pain relief and functional improvement in iatrogenic spondylodiscitis, even with LPS placement. However, FEDD may not correct spinal deformities and is unsuitable for advanced spinal disease or instability. Early detection of spondylodiscitis is crucial for improved outcomes.
Journal of Minimally Invasive Spine Surgery and Technique.2024;9(1):37-45. doi:10.21182/jmisst.2023.01123
Objective:
Awake spine surgery has improved patient outcomes in common orthopaedic procedures. Integrating it into spine surgery is of interest to surgeons since it may reduce the difficulties and complications associated with general anaesthesia. The demand for safe spine surgery is rising due to healthcare improvements and increasing ageing population. This study aimed to assess the safety and feasibility of spine surgery under spinal anesthesia for elderly patients aged 65 and older.
Methods:
In a retrospective review, 83 lower lumbar spine surgeries performed under spinal anesthesia by a single surgeon at a single hospital from 2015 to 2019 were examined. All procedure-related data was collected prospectively for analysis. This study explored demographic characteristics, surgical features, perioperative concerns, and anesthesia-related obstacles in spine surgery under spinal anaesthesia.
Results:
This study included 83 patients aged 65 years and older. Following follow-up, visual analogue scale and Oswestry Disability Index scores considerably improved (p<0.05). Patients in the American Society of Anesthesiologists physical characteristics classification grade II had the highest count. The most common level was L4–5. About 7.2% of patients needed multiple spinal procedures. The average induction time was 20.2±9.6 minutes. The average intraoperative operation lasted 84.0±17.20 minutes. The shifting-out process took 7.95±2.10 minutes to start. The mean intraoperative arterial blood pressure was 70.7±10.8 mmHg, and the mean heart rate was 69.0±7.2 beats per minute. The average postoperative analgesia initiation time was 79.9±7.7 minutes. The average postoperative stay was 3.02±0.83 days. In 10.8% of individuals, cerebrospinal fluid was found. 1.2% of patients experienced postoperative hypotension, 12% experienced nausea and vomiting. Infection occurred in 2.4% of patients, and 14.5% experienced post-operative urinary retention.
Conclusion
This case series shows that older patients can undergo lumbar fusion, decompression surgeries under spinal anesthesia with a skilled anaesthesia team. Additionally, spinal anaesthesia substantially minimised dangers and concerns related with general aanaesthesia.
Less Invasive Triangular Osteosynthesis in the Management of AO Type-B Unstable Sacral Fractures
Journal of Minimally Invasive Spine Surgery and Technique.2024;9(1):51-60. doi:10.21182/jmisst.2023.01088
Objective:
This prospective cohort study investigated the clinical and radiological efficacy of triangular osteosynthesis (TO) in the management of AO type-B unstable sacral fractures.
Methods:
All patients with unstable AO type-B sacral fractures were included in this study. They were evaluated clinically and radiologically and underwent TO. Pre- and postoperative clinical parameters included the visual analogue score (VAS) for back pain, Oswestry Disability Index (ODI), and Gibbon classification. Radiological parameters included x-rays and multislice 3-dimensional computed tomography scans of the pelvis and the Tornetta and Matta criteria for fracture reduction.
Results:
This study included 30 patients (17 males and 13 females; mean age, 31.63±9.65 years). The reported causes of trauma were a fall from height in 17 patients, road traffic accident in 11 patients, and hard objects falling onto the pelvis in 2 patients. According to the AO spine sacral fracture classification system, 8 cases were type B2 and 22 were type B3. At the last postoperative follow-up, the mean VAS improved from 7.77±1.19 preoperatively to 3.97±1.59 (p<0.001), the mean ODI was 15.27±3.34, and the Gibbon classification of cauda equina injury improved from 2.87±0.97 preoperatively to 1.27±0.52 (p<0.001). According to Tornetta and Matta criteria for fracture reduction, the results were excellent (<4 mm) in 73.3% of patients, good (4–10 mm) in 20%, and fair (10–20 mm) in 6.7%. All patients experienced complete fracture healing.
Conclusion
TO is a less invasive, safe, and effective option for the management of unstable AO type-B sacral fractures with good clinical and radiological outcomes.
Country
Republic of Korea
Publisher
Korean Minimally Invasive Spine Surgery Society
ElectronicLinks
http://jmisst.orgEditor-in-chief
Hyeun Sung Kim
komisskomiss@gmail.com
Abbreviation
J Minim Invasive Spine Surg Tec
Vernacular Journal Title
ISSN
2508-2043
EISSN
2508-2043
Year Approved
2025
Current Indexing Status
Currently Indexed
Start Year
2016
Description
Journal of Minimally Invasive Spine Surgery and Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS), Minimally Invasive Spine Surgeons Association of Bharat (MISSAB), Taiwan Society of Minimally Invasive Spine Surgery (TSMISS), Taiwan Society of Endoscopic Spine Society (TSESS), Brazilian Minimally Invasive Spine Surgery Society (BRAMISS), Latinamerican Endoscopic Spine Surgery Society (LESSS), Spanish Endoscopic and Percutaneous Spine Surgery Society (SECPEC), Malaysia Society of Endoscopic Spine Surgery (MSESS), and Thai Society for Minimally Invasive Spine Surgery and Techniques (ThaiMISST) for the publication of research results about minimally invasive spinal surgery (MISS). JMISST will consider submissions in areas of endoscopic spinal surgery, minimally invasive procedure for degenerative spine disease, pain intervention, minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. JMISST provides spine physicians and researchers with peer-reviewed articles on minimally invasive spine surgery to improve patient treatment, education, clinical or experimental research, and professionalism. In particular, minimally invasive spine surgery, including endoscopic spinal surgery, will be the most important field in the future spinal treatment. JMISST is the only journal in the world that is currently focused on minimally invasive spine surgery. We aim to lead the field of minimally invasive spine surgery to be developed in the future, and will contribute to providing a happy life for humans based on academic development.
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