The Role of Minimally Invasive Spine Surgery

Introduction :In the past half of century, the spinal surgery techniques has advanced significantly. Along with the improvement and various of techniques and technologies in general, there has been a big movement to reduce the morbidity of surgery. Case review : As opposed to open spine surgery, minimally invasive surgical approaches can be faster, safer and require less recovery time. The minimally invasive spine surgery also need to make an efficient target of surgery. The roots in minimally invasive spine surgery (MISS) are based primarily on technique modifications. Discussion: The Williams microdiscectomy, described in 1978, revolutionized MISS by starting the evolution of lumbar discectomy from an open surgery through a 6-inch incision to a microsurgical approach through as small an opening as possible. Conclusion :We don’t use the MISS technique when the extension of tumor is more than 2 levels; extension of the tumor is 20% longer than diameter of largest retractor; the tumor > 3cm for interlaminary approach, the wide durotomy is needed; and also the case with intramedullary tumor with 80% extention, from left to the right side; en bloc as the the goal of surgery for extradural tumo

Principles of Spine Instrumentation

Introduction : Spinal implants were initially, and are still, used for the supplementation of bony fusion. However, bony fusion operations were initially performed without implants.1 In the US, Wire and screw fixation of the unstable spine techniques remained to use until the pre-World War II years. 20 years after World War II, there were two major breakthroughs in spine surgery: the Harrington system for spine stabilization and deformity correction and the interspinous wiring technique of Rogers. Rogers described the technique of cervical interspinous wiring in the early 1940s. Harrington introduced his instrumentation system in 1962. Discussion : Since then, modifications of both techniques have been devised to increase their security of fixation. The next significant advance in dorsal spinal stabilization was the development of multisegmental spinal instrumentation. Multisegmental instrumentation permits sharing of the load applied to the instrumentation construct with multiple vertebrae, so that decreasing the chance of failure at the metal–bone interface.The Luque segmental wiring technique, developed in the early 1970s, was the first of this class of implants to achieve wide clinical application. Subsequent modifications have been used. Conclusion : Further modifications were the forerunners of more complex, currently used systems of universal spinal instrumentation (USI)

Cervical Spine Trauma

Cervical trauma is a serious condition, that may cause permanent disability or even death. Cervical trauma occurs in 2-7% of blunt trauma patients. In Europe, the incidence of cervical trauma is approximately 9-17/100,000 annually,. The most common mechanisms of injury causing cervival trauma are traffic accidents and falls, which the most commonly injured vertebra is vertebral C2 (axis). Diagnostics of cervical trauma are based on good clinical assessment and prompt radiological imaging. Several patient groups, such as the elderly and patients with traumatic brain injury are highly susceptible to cervical trauma. The diagnostics of cervivcal trauma remain challenging for clinical practitioners and failure to diagnose cervical trauma in acute care may have serious consequences

Robotic Surgery for Giant Presacral Dumbbell-Shape Schwannoma

Objective: To demonstrate the feasibility of using da Vinci robotic surgical system to perform spinal surgery.Methods: Magnetic resonance imaging (MRI) of a 29-year-old female patient complaining right pelvic pain for 1 month revealed a 17x8x10 cm non-homogeneous dumbbell shape encapsulated mass with cystic change located in the pelvic cavity and caused an anterior displacement of urinary bladder and colon.Results: There was no systemic complication and pain decrease 24 hours after surgery and  during 2 years of follow up. The patient started a diet 6 hours after the surgery and was discharged 72 hours after the surgery. The pathological diagnosis of the tumor was schwannoma. Conclusions: Giant dumbbell shape presacral schwannomas are rare tumours and their surgical treatment is challenging because of the complex anatomy of the presacral. Clinical application of da Vinci robotic surgical system in the spinal surgical field is currently confined to the treatment of some specific diseases or procedures. However, robotic surgery is expected to play a practical future role as it is minimally invasive. The advent of robotic technology will prove to be a boon to the neurosurgeon.Keywords: da Vinci robotic surgical system, presacral, schwannoma DOI: 10.15850/ijihs.v3n1.40

Robotic Surgery for Giant Presacral Dumbbell-Shape Schwannoma

Objective: To demonstrate the feasibility of using da Vinci robotic surgical system to perform spinal surgery.Methods: Magnetic resonance imaging (MRI) of a 29-year-old female patient complaining right pelvic pain for 1 month revealed a 17x8x10 cm non-homogeneous dumbbell shape encapsulated mass with cystic change located in the pelvic cavity and caused an anterior displacement of urinary bladder and colon.Results: There was no systemic complication and pain decrease 24 hours after surgery and  during 2 years of follow up. The patient started a diet 6 hours after the surgery and was discharged 72 hours after the surgery. The pathological diagnosis of the tumor was schwannoma. Conclusions: Giant dumbbell shape presacral schwannomas are rare tumours and their surgical treatment is challenging because of the complex anatomy of the presacral. Clinical application of da Vinci robotic surgical system in the spinal surgical field is currently confined to the treatment of some specific diseases or procedures. However, robotic surgery is expected to play a practical future role as it is minimally invasive. The advent of robotic technology will prove to be a boon to the neurosurgeon.Keywords: da Vinci robotic surgical system, presacral, schwannoma DOI: 10.15850/ijihs.v3n1.40

A Laminectomy Decompression in Radiculopathy Vertebrae L3-L4, L4-L5: A Case Report

Abstract. Introduction: Spinal tumors are uncommon lesions and affect only a minority of the population. Spinal metastases comprising approximately 97% of masses encountered with spinal imaging and is the most common site of metastasis from breast cancer. The sign and symptom for metastatic spinal tumors is varied from back pain, motoric and sensoric dysfunction and in advanced disease, spinal cord compression.Case Report: In this case, we report a 39-year-old female patient with complaints of weakness in the lower limb with history of breast cancer. The patient underwent a contrast lumbosacral MRI examination and found the patient has metastatic spine tumors. The patient was then planned to undergo laminectomy decompression, tumor resection, and posterior stabilization procedures. Conclusion: Spinal tumors is a condition that can arise within spinal cord itself or from the adjacent structures. It affects only a minority of the population. The hallmark symptom for spinal metastases is back pain. Surgical techniques such as open decompression and stabilization are used from the condition of the patient who has a neurodeficit and compression from radiological examination with good prognosis.   Keywords: Breast cancer, Metastatic spinal tumors, Neurosurgery, Weaknes

Brachial Plexus Surgery

The magnitude problems of brachial plexus lesions are not only about the surgical approaches but also the basic problems. Its vague clinical symptoms, the complexity of anatomy structure, the use of advanced imaging followed by electrophysiology to address the lesions, and the challenging of surgical timing and options make those lesions management more challenging. These challenges in Indonesia are more difficult because not so many neurosurgeons are familiar with brachial plexus surgery.Brachial plexus surgery is in evolution. For brachial plexus nerve sheath tumours, a fascicular level resection of tumours and preservation of uninvolved fascicles is now possible. Neuropathic pain may be improved by a dorsal root entry zone lesion procedure. The timing of surgery is different in each pathology, especially in traumatic injury. In traumatic injury, it depends on several factors, e.g. the mechanism of injury, type of injury, the speed of the vehicle, and the mode of fall while victim lands on the ground.The common surgical options in traumatic injury are direct repair by means of an end-to-end suture, external neurolysis, nerve grafting, and nerve transfers. Secondary reconstruction to improve function has been widely introduced such as soft-tissue reconstruction (tendon/muscle transfer or free muscle transfer) and bone procedures (arthrodesis or osteotomy). Brachial plexus surgery demands a broad multidisciplinary approach to a common problem, targeting not only the peripheral nerve, but also the brain, spinal cord, muscle, end-organ, bone and joints, and their complex interactions.

MINIMALLY INVASIVE SURGERY: A CONCEPTUAL REVIEW

We are living in an era that performs minimally invasive approaches to many surgical aspects, and spine surgery is not an exception. Nowadays, minimally invasive spine surgery is a routine procedure in many countries around the world. It began in the mid-twentieth century and has now developed into a large field of progressive spinal surgery. This paper will review the philosophy, indications, patient selections, advantages, and disadvantages of minimally invasive spinal surgery

Cervical Spine Trauma Management

The incidence of spine injury following accidents are still very high in developing countries. Many problems occur after the accident including primary intervention on the scene, transportation to the public primary hospital, the referral system, and finally, the management at the central hospital.Cervical spinal cord injuries represent 20-33% of total spinal injuries with the prevalence of the subaxial levels. In patients with a preoperative neurological deficit due to spine trauma, in case of spinal cord compression or instability, surgery is often the treatment of choice to grant a chance of neurological recovery, early mobilization, and faster return to usual daily activities compared to the conservative treatment. In the past, many authors suggested a delayed surgical treatment to reduce postoperative complications rate, but recent studies have shown that an early decompression (<72 h) may facilitate a postoperative neurological improvement probably due to the prevention of the secondary mechanisms of damage in acute SCI.In the context of the advanced management of spinal injuries, the main points of the focused assessment, the important waypoints of a full classification of the skeletal and spinal cord injury, the principles of early prioritization and decision making, the outline of the surgical strategy including indications, timing, approaches, technique and post-operative care, and the outline principles of rehabilitation. The authors in this paper try to summarize and create a guideline of management, based on experience in a regional centre

Percutaneous Epidural Adhesiolysis (PEA) untuk Manajemen Nyeri Pinggang Bawah Kronis

Latar Belakang dan Tujuan: Nyeri pinggang bawah yang disebabkan oleh penekanan radik saraf tulang belakang maupun thecal sac sering dijumpai dan dapat menimbulkan kecacatan. Percutaneous epidural adhesiolysis (PEA) adalah salah satu tindakan yang dilakukan untuk mengatasi nyeri sehingga penelitian ini bertujuan untuk mengevaluasi efektifitas PEA menggunakan lidokain 2% dalam mengatasi nyeri pinggang bawah. Subyek dan Metode: Penelitian cohort retrospektif dengan lima data pasien diambil dari database bagian Bedah Saraf. Semua pasien dilakukan PEA dengan injeksi anestesi lokal menggunakan 5 mL lidokain 2%, pengukuran luaran menggunakan Visual Analog Score (VAS), Oswestry Disability Index (ODI) dan penggunaan obat opioid yang dianalisa pada bulan ke-3 dan 6 bulan setelah tindakan. Hasil: Usia tertua adalah 60 tahun dengan 80% penderita adalah laki-laki dengan nilai maksimum VAS sebelum tindakan adalah 9, VAS 3 bulan pascatindakan adalah 3 sedangkan VAS 6 bulan pascatindakan adalah 2. Sehingga terdapat perbaikan VAS dan ODI yang signifikan (Friedman test dan post hoc Wilcoxon test) dengan nilai p0,05. Satu pasien tetap menggunakan opioid hingga 6 bulan pascatindakan PEA. Simpulan: Pengurangan nyeri yang signifikan disertai dengan perbaikan status fungsional terjadi pada pasien yang diberikan PEA dengan menggunakan anestetika lokal lidokain 2%.   Percutaneous Epidural Adhesiolysis (PEA) for Chronic Low Back Pain Management Background and Objective: Chronic low back pain caused by compression of spinal nerves roots or thecal sac is common and can lead to disability. Percutaneous epidural adhesiolysis (PEA) is an interventional pain management to relieve the pain.This study aims to evaluate the effectiveness of the PEA using lidocaine 2% in relieving lower back pain. Material and Methods: This retrospective cohort study was done using five patient’s data taken from medical record, with all patients had underwent PEA using 5 mL of 2% lidocaine, outcome measurements were evaluated using Visual Analogue Score (VAS), Oswestry Disability Index (ODI) and the useage of opioid drugs at 3rd and 6th month afterward. Results: The oldest age was 60 years and 80% of patients were male with a maximum value of VAS before procedure was 9, VAS score at 3rd month was 3 and VAS score at 6th month was 2. The maximum value ODI before procedure was 90, ODI at 3rd month was 50, while the 6th month was 25. Friedman test and post hoc Wilcoxon test revealed a significant difference in VAS score between before procedure, 3rd month and 6th month post-procedure (p 0,05). Conclusion: PEA with lidocaine 2%, is an effective treatment for chronic low back pain and can reduce pain thus increase fungsional state significantly