Spine News
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The future of spinal surgery is minimally invasive —
Four questions for
Prof. Paulo Pereira
Question: what makes Minimally Invasive Surgery (MIS) so promising in the area of spinal surgeries?
Prof. Pereira: Whilst there is no singular definition of Minimally Invasive Surgery, we generally aim to limit soft tissue retraction as much as possible. This has several positive effects: An observational study on MIS in one- or two-level fusion to treat degenerative lumbar disorder1 indicated significantly quicker recovery time after surgery, thereby leading to a shorter hospital stay. In addition, a systematic review2 demonstrated that blood loss could be reduced up to 88% in MIS lumbar fusion compared to open techniques.
Question: what are the challenges surgeons usually face with MIS?
Prof. Pereira: A key issue with MIS affecting patient and surgeon alike is radiation exposure. In using minimally invasive techniques, surgeons have reduced ability to navigate, as surface matching and anatomic landmarks are available on a limited scale. Therefore, they need repeated interoperative imaging, e.g., through radiography. Advanced intraoperative imaging techniques, such as 3D fluoroscopy, O-arm or CT, combined with navigation considerably reduce radiation exposure to the surgical team.3
However, segmental motion of the vertebrae, e.g., through pressure on the patient, remains a challenge even with navigation. A robot fixed to the patient like MAZOR™ can decrease this motion and thereby further increase precision.4
Question: what are the most promising areas for MIS and which are less favourable?
Prof. Pereira: TLIF and PLIF remain the most versatile procedures to relieve back- and leg pain caused by disc degeneration, spinal stenosis and spinal instability. However, new minimally invasive approaches have been introduced to optimize the surgical results for some patients.
This is the case of lateral approaches (LLIF/OLIF) in patients with spinal deformities since these techniques allow to optimize lordosis and disc and foraminal height. MDLIF is another recent technique filling the gap between open and MIS surgery, combining a midline approach with an alternative pedicle screw fixation, which significantly reduces the need for soft tissue retraction.5
Intraoperative imaging using Medtronic’s O-Arm in combination with advanced navigation, e.g., using MAZOR™, extends the benefits of these techniques to a new level of accuracy and safety while also reducing radiation exposure to the patient as well as the surgical team.3,4
Question: and what about the cost effectiveness?
Prof. Pereira: Cost effecttiveness is an important factor for hospitals and health insurance companies alike. A study6 on the cost effectiveness of minimally invasive techniques in lumbar spinal fusion found that the costs related to operation and equipment are typically higher than in open surgery.
However, the higher costs are balanced out by factors such as lower transfusion rate, enhanced recovery after surgery and shorter length of hospital stay.
References
- Franke et al. Cureus., 2016
- Goldstein et al. Spine, 2016
- Grelat M, Zairi F, Quidet M, Marinho P, Allaoui M, Assaker R Neurochirurgie, 2015
- Van Dijk JD, van den Ende RPJ, Stramigioli S, Köchling M, Höss N. Spine, 2015
- Bruffey JD, Regan J, McMilan M, Ingram R, Bondre S. Center For Advanced Spinal Surgery of Southern Arizona, 2015
- Vertuani et al. Value in Health, 2015
The data and content included in this presentation express only the clinical perspective of the presenter. They are completely independent and do not necessarily reflect the opinions of Medtronic.
The commercial name of Mazor™ is Mazor X Stealth™ Edition.
See the device manual for detailed information regarding the instructions for use, indications, contraindications, warnings, precautions and potential adverse events. For further information, contact your local Medtronic representative and/or consult the Medtronic website at www.medtronic.eu.