Cervical spondylotic myelopathy: The role of posterior decompression, arthrodesis, and instrumentation

Cervical spondylotic myelopathy (CSM) is an insidious, progressive disease process that presents with a number of symptoms frequently refractory to conservative non-operative treatments that often require operative intervention. Nevertheless, controversy exists over the optimal choice of surgical treatment for CSM. For patients with progressive symptoms despite nonoperative therapy, posterior decompression is an appropriate treatment option dependent upon location of pathology, extent of degenerative disease, and cervical alignment. Fusion and instrumentation is a further adjunct to posterior cervical decompression and has gained popularity as a method of maintaining cervical spine stability and alignment following decompression.link_to_subscribed_fulltex

Techniques for the Operative Management of Thoracic Disc Herniation: Minimally Invasive Thoracic Microdiscectomy

Thoracic disc herniations are uncommon lesions that are asymptomatic in most patients; however, for individuals who present with persistent radiculopathy that is nonresponsive to conservative treatment or with myelopathic symptoms with or without radiculopathy attributed to a thoracic disc herniation, operative intervention of the thoracic spine is sought. Various procedures and approaches for the treatment of thoracic disc herniations have been reported, but they have been associated with numerous intraoperative complications and postoperative morbidities. This article discusses a novel minimally invasive procedure for the surgical treatment of thoracic disc herniations referred to as a minimally invasive thoracic microdiscectomy. It uses a series of muscle dilators, a tubular retractor, and microscopic visualization by way of a posterolateral approach in an effort to minimize many of the complications that are associated with the more traditional approaches. © 2007 Elsevier Inc. All rights reserved.link_to_subscribed_fulltex

Anterior cervical discectomy and corpectomy

OBJECTIVE: The objective of this review article is to describe the authors' operative technique for performing anterior cervical corpectomy and fusion. METHODS: The authors reviewed their operative technique and experience to clearly detail the general methods utilized to safely and effectively perform anterior cervical corpectomy and fusion. Specific nuances peculiar to the authors' technique were identified and highlighted. RESULTS: The operative technique for anterior cervical corpectomy, including nuances for enhancing ease or outcome of surgery, is described in detail. Drawings and photographs are included where appropriate to highlight specific aspects of the procedural technique. CONCLUSION: Anterior cervical corpectomy and fusion is a well known technique that proceeds in a consistent and logical sequence of maneuvers. Specific technical nuances at various points enhance the ease and safety of the technique, as well as the completeness of the eventual result. Copyright © Congress of Neurological Surgeons.link_to_subscribed_fulltex

Minimally Invasive Spine Surgery: A Historical Perspective

Minimally invasive spine surgery has gained considerable momentum and increased acceptance among spine surgeons throughout the years. An understanding and awareness of the development of minimally invasive spine surgery and its role in the operative treatment of various spine conditions is imperative. This article provides a succinct historical perspective of the development of spine surgery from the more traditional, open procedures to the use of more "minimal access" or minimally invasive spine surgery procedures. © 2007 Elsevier Inc. All rights reserved.link_to_subscribed_fulltex

Thoracic microendoscopic discectomy

Object. Various approaches exist for the treatment of thoracic disc herniation. Anterior approaches facilitate ventral exposure but place the intrathoracic contents at risk. Posterolateral approaches require extensive muscle dissection that adds to the risk of postoperative morbidity. The authors have developed a novel posterolateral, minimally invasive thoracic microendoscopic discectomy (TMED) technique that provides an approach to the thoracic spine which is associated with less morbidity. Methods. Seven patients 23 to 54 years old with nine disc herniations underwent TMED. All lesions were soft lateral or midline thoracic disc herniations. Under fluoroscopic guidance with the patient positioned prone, the authors used a muscle dilation approach and the procedure was performed with endoscopic visualization through a tubular retractor. Based on a modified Prolo Scale, five patients experienced excellent results, one good, and one fair. No case required conversion to an open procedure. The mean operative time was 1.7 hours per level, and estimated blood loss was 111 ml per level. Hospital stays were short, and no complications occurred. Conclusions. The TMED is safe, effective, and provides a minimally invasive posterolateral alternative for treatment of thoracic disc herniation without the morbidity associated with traditional approaches.link_to_subscribed_fulltex