The main minimally invasive spine surgical treatment programs that are routinely performed are
1 . Cervical and lumbar intervertebral disc plasma ablation and radiofrequency thermal coagulation;
2, percutaneous puncture vertebroplasty;
3. Lateral posterior foraminoscopy and discoscopic lumbar disc removal;
4. Minimally invasive small incision lumbar disc removal + non-fusion interspinous fixation;
5. Microscopic lumbar disc removal and intervertebral fusion under pipeline; Xiao Dan, Department of Orthopedics, Guangdong Provincial People’s Hospital
6. Microscopic anterior and posterior cervical decompression and fixation fusion or artificial disc replacement;
7. Thoracoscopic and retroperitoneoscopic anterior thoracic and lumbar spine surgery;
Technology introduction
1.Cervical intervertebral disc radiofrequency ablation
It is mainly suitable for patients with early cervical disc bulge, mild compression of spinal cord and dural sac, with sympathetic symptoms such as dizziness, panic, chest tightness and eye distention. Spinal cord type cervical spondylosis is not suitable.
2.Lumbar intervertebral disc ablation
It is mainly suitable for early lumbar disc degeneration, and the clinical symptoms are mainly simple lower back pain. The MR of lumbar spine mainly shows black disc, disc bulge and no nerve root compression symptoms. The treatment by C-arm guided disc puncture has certain efficacy. It is not recommended for patients with obvious disc herniation compressing nerve roots.
3.Percutaneous vertebroplasty
It is mainly suitable for elderly patients with osteoporotic vertebral compression fractures and intractable bone pain caused by metastatic tumors of the spine. A C-arm guided, trans-arch puncture technique is used to place the working canal. For the degree of compression of the vertebral body, bone cement infusion can be performed by either PVP or PKP. PVP is mainly used for patients with low compression of the vertebral body, and PKP technique, called balloon dilated repositioning, vertebroplasty, is used for patients with higher compression of the vertebral body, where the compressed vertebral body can be repositioned by means of a hydraulic balloon and injected with bone cement to strengthen the vertebral body. These two minimally invasive treatment techniques have remarkable efficacy and are very popular among elderly patients.
4.Intervertebral disc removal under discoscopy and minimally invasive small incision
It is mainly suitable for young patients with simple disc herniation. Due to the young age of the patient, there is no obvious bone growth and the stability of the lumbar spine is better. Simple removal can be used to obtain a better outcome. The discoscopic procedure is performed with an incision of only about 15 mm and a quick postoperative recovery. Small incision surgery under C-arm precise positioning with 2`3 cm incision, Xtube or minimally invasive Codman pull hook is used to reveal and the disc is removed with the assistance of microscope, and the surgical result can be comparable to discoscopy.
5.Lumbar decompression and fusion surgery under minimally invasive tube
This technique is done under a specially designed minimally invasive surgical canal, using a small incision and soft tissue expander step-by-step expansion technique to complete the surgical exposure, minimizing the stripping of soft tissues such as muscles. At the same time, the surgery is performed with the assistance of a high-powered surgical microscope, and decompression is complete. It not only removes the intervertebral disc, but also perfectly deals with complex lesions such as spinal stenosis, lateral saphenous fossa stenosis and osteophytes, and simultaneously solves problems such as recurrence of lumbar disc herniation and lumbar spine instability. The efficacy is better than that of traditional surgery. Decompression and fixation of the lumbar spine through the paravertebral muscle access, Xtube, Qudrant and other tubes is a promising minimally invasive surgery of the lumbar spine. Compared with traditional surgery, the surgical approach has minimal stripping of the paravertebral muscles and minimal disturbance to normal tissues, but it can perform the exact same operations as traditional surgery, such as discectomy, intervertebral bone grafting and fusion, and internal fixation, with better surgical results than traditional surgery. It is a promising minimally invasive technique, especially suitable for patients with single stage and lumbar spine with less than 2 segments. Compared with other minimally invasive surgeries, the biggest advantage of this technique is that the indications are wider, and the surgical injury is smaller because the surgical access is via the paravertebral muscle microinvasive method. Moreover, the decompression is complete, and the technical difficulties of fusion and fixation can be solved at the same time. It can be suitable for more patients.
6.Microscopic anterior cervical decompression and fixation fusion or artificial disc replacement;
Microscope-assisted anterior cervical decompression has become the technical standard for spine surgery in western developed countries. This technique is rarely performed in the domestic orthopedic community, mainly due to the general lack of basic training in neurosurgery for spine surgeons in China. With the development of spine surgery, there is a need to promote this technique in the orthopaedic community because of the increasing demands on the accuracy, effectiveness and safety of anterior cervical decompression surgery. We have gradually established this technical standard in anterior cervical decompression surgery since 2007, and have applied hundreds of cases so far.
7.Thoracoscopic and retroperitoneoscopic anterior thoracic and lumbar spine surgery
Thoracoscopic techniques have been successfully used for thoracic discectomy, thoracic lesion removal, anterior release and internal fixation of scoliosis. In addition to the standard “locked hole” thoracoscopic technique for lesion biopsy removal and discectomy, the expanded incision operation technique is both minimally invasive and easy to handle complex surgery, which can meet various needs. The expanded incision technique is both minimally invasive and convenient for complex surgery, and can be used for a variety of patients who require anterior thoracic surgery. Although thoracoscopic spine surgery is not yet common due to the limitations of equipment and technology, and because thoracic spine lesions are far less common than lumbar spine lesions, thoracoscopic discectomy, thoracic lesion removal, and anterior release have significant advantages in spine surgery compared with more invasive open-heart surgery. The most applied posterior laparoscopic-assisted spine surgery technique is laparoscopic anterior lumbar fusion, which can also be used for focal resection of lumbar spine tumors and tuberculosis with bone grafting and fusion and internal fixation, and also for various types of surgery such as decompression, bone grafting and internal fixation of spinal fractures.