Artikel
Mini-open approach in instrumented lumbar spinal surgery: Results of 90 patients with lumbar pedicle screw fixation and interbody fusion
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Veröffentlicht: | 21. Mai 2013 |
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Objective: Minimal invasive surgery (MIS) is increasingly used for instrumented spinal fusion aiming to reduce intraoperative trauma, operation times and hospital stay. The aim of this current study was to assess the accuracy, safety, invasiveness and patient satisfaction in posterior instrumentation using a mini-open approach (MOA).
Method: MOA using spinal navigation is characterized by a midline standard incision without anatomical visualization of the classic entry points for pedicle screws. We retrospectively reviewed 90 consecutive cases from a single neurosurgeons series undergoing lumbar fusion and decompression for degenerative and isthmic spondylosis performed within 2 years. The clinical outcome was evaluated with respect to pain relief, early radiological outcome, operative times, blood loss, necessity of blood transfusion, patient satisfaction, medical and surgical complications. Pre- and postoperative lab parameters were determined. The results of the first year patients (n = 45, gr1) were compared to those of the second year patients (n = 45, gr2).
Results: 427 screws were placed, 15 were cement augmented. No new permanent neurological or aggravation of previous deficits occured. 3 complications required surgical revision (2 superficial wound healing disorders, 1 epidural hematoma). 1 patient was revised for screw displacement one year after surgery. Furthermore, myocardial infarction and cerebellar infarction occurred in one patient each. At follow-up after 3 months, 94,4% of the patients were satisfied. In 2 cases minor changes of the cage position were noticed with neither concomitant complaints nor operative revisions. A statistically significant difference in hemoglobin, hematocrit and CRP pre- to postoperatively was noticed making single blood transfusions necessary in 7,7%. Comparing the lab parameters of the first 45 patients with the second half, did not reveal any significant difference amongst the groups, however, in gr1 11,1% of patients required blood transfusion compared to 4,4% in gr2. The surgeons experience increased rapidly, with an overall significant decrease in surgical time after the first 45 patients from 325min to 270min reflecting the learning curve.
Conclusions: Using the navigated spinal MOA in instrumented lumbar spinal fusion surgery can be safely performed harboring a specific screw complication rate of 1,1% and an overall complication rate of <8%. Surgical trauma as indicated by lab values and blood loss are low and meet the criteria for MIS.