Minimally Invasive Spine Surgery
Description
Don't miss it! The second, completely revised and expanded edition of the successful surgical manual on minimally invasive spine surgery includes 51 chapters (including more than 20 new chapters) covering all current minimally invasive techniques in spine surgery. A complete survey of all microsurgical and endoscopic techniques with a special focus on semi-invasive injection techniques for diagnostic and therapeutic purposes in low back pain is given. The clear chapter structure with terminology, history, surgical principles, advantages/disadvantages, indications, access principles, complications, and results facilitates navigation through the manual. Topics include the principles of microsurgical and endoscopic treatment, spinal navigation and computer-assisted surgery, minimally invasive reconstruction, fusion, dynamic stabilization in fractures, degenerative disc disease, spinal stenosis, low back pain and deformities. The didactic presentation of surgical steps makes the reader familiar with all types of new minimally invasive techniques in clinical use or still in ongoing clinical trials such as minimally invasive spine arthroplasty.
Reviews / Votes
From the reviews of the second edition:
The book covers almost all commonly used minimally invasive surgical procedures. The first section deals with the microscope and operating room setup. Challenging procedures of the cervical spine include a detailed technique for treating the odontoid fracture, microsurgical total cervical disc replacement, and microsurgical stabilization of C1-2 fusion. Microsurgical approaches and endoscopic principles are very well covered for the thoracic and lumbar spine. A section on disc reconstruction describes cutting-edge procedures such as autologous chondrocyte transplantation and nucleus pulposus replacement. Spinal stenosis, spinal fusions, and dynamic stabilizations are described in detail. The book is well illustrated and referenced by the authors. Photos showing the position of the patient on the operating table are most useful....This is perhaps the best book written on the subject. I very highly recommend it to all spine surgeons and orthopedic and neurosurgical trainees. (5 Stars Doody's review by Edward Abraham)
"This is an excellent book! Edited by H. Michael Mayer, it is a multiauthor mix of European, American, Swiss and Australian, but predominantly German and North American current and cutting edge spinal practice. It is remarkable that in less than 500 pages . the entirety of spinal surgery from trans-oral odontoidectomy to low lumbar dynamic stabilisation can be summarised so eloquently and comprehensively. . this book should be essential reading for every spinal surgeon and occupy a prominent place in every departmental library." (Barrie D. White, Acta Neurochirurgica, Vol. 148 (6), 2006)
"This is the second edition of a book that puts great effort into covering all aspects of minimally invasive surgery of the spine (MISS). . The individual chapters are thoroughly structured and easy to overview. The illustrations are generally of high quality . . the book is so well written andwell structured that it is a pleasure to read it from beginning to end. . This excellent book is a must for everyone interested in spine surgery . ." (Björn Strömqvist, Acta Orthopaedica, Vol. 77 (4), 2006)
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Content
4 Microsurgical Instruments ( p. 16)
A. Korge
As in all surgical fields, an enormous tendency has occurred recently toward minimizing both surgical procedures as well as surgical approaches. The reasons for miniaturized approaches include a reduced infection rate due to shortened skin incisions, less cosmetic alterations, as well as the fact that in the majority of cases, small and localized pathologies only need small and limited approaches.
In addition, small incisions need less time for wound closure, thus reducing the overall time of surgery [4]. This tendency is also found in spine surgery with an increasing shift frommacrosurgery tomicrosurgery [1, 2, 3, 5]. Microsurgery has become quite popular, especially in surgical procedures within the spinal canal [3], and has been established within recent decades basically due to the development of efficient optical aids such as powerful and effective surgical microscopes which are being continuously improved.
However, the use of microscopes in spine surgery delivered a new intermedium between the surgeon’s eye and the operating field, thus influencing simultaneously the individual visual axis between the surgeon’s eye and his hands. Therefore, the surgeon’s line of vision was restricted and the field of vision became smaller and limited. In addition, the line of vision of a microscope is perpendicular to the surgical area to be operated on.
Consequently, the configuration of surgical instruments had to be modified (e.g., bayonet-shaped), as well as their basic dimensions (e.g., smaller and longer), in order to fulfill the specific requirements of microscope-assisted surgery. Depending on the anatomical area and the number of segments being approached, surgery can be started with either microscopic or macroscopic techniques. Usually, mono- or bisegmental pathologies on the lumbar spine (disc herniation, lumbar spinal stenosis) can be done by a skin-to-skin technique with microscope assistance from beginning to end.
In multisegmental decompression surgery, for example due to lumbar spinal stenosis, initial macroscopic preparation down to the interlaminar windows and subsequent use of the microscope might save time.
4.1 Classification of Instruments
Instruments for spinal microsurgery can usually be divided into two major groups:
1. The first group is especially related to the approach from the skin down to the spinal canal, including skin opening, traversing soft tissue subcutaneous, transfascial, and paravertebral to the interlaminar window, and entering the spinal canal.
2. The second group is related to surgical procedures within the spinal canal and within the intervertebral disc space. Some instruments are effective in both groups (cautery, high-speed drills, suction devices), as ismentioned later on.
4.1.1 Instruments Related to the Approach
4.1.1.1 Instruments for Wound Opening
There is basically no big difference betweenmicroscopic and macroscopic instruments for opening the skin even when using the microscope from the beginning. Standardized incision scalpels serve to open the skin and to traverse the subcutaneous tissue. Forceps of standard size and length can be used for skin and tissue retraction, however, delicate forceps such as Adson forceps are more comfortable under microscope assistance.
