Key Concepts and Techniques for Minimally Invasive Posterior Lumbar Surgery

Abstract

The key principles that define minimally invasive spine surgery include:(1) avoid muscle crush injury caused by self-retaining retractors; (2) preserve tendon attachment sites of key muscles, particularly multifidus; (3) use known anatomic neurovascular planes; and (4) decrease collateral soft-tissue injury by limiting the width of the surgical corridor.With traditional posterior lumbar surgery, the tendon origin of the multifidus muscle is detached, the surgical corridor is exceedingly wide, and significant muscle crush injury occurs through the use of powerful self-retaining retractors. This combination of factors leads to well-described changes in muscle physiology and function. Minimally invasive posterior lumbar surgery is performed using table-mounted tubular retractors that focus the surgical dissection to a narrow corridor, directly over the surgical target site. The path of the surgical corridor is based on anatomic planes specifically chosen to avoid injury to the musculotendinous complex and the neurovascular bundle. The results achieved with minimally invasive spine surgery are comparable to those of traditional open techniques, but with less postoperative pain, less blood loss, and lower rates of deep infection. However, minimally invasive techniques remain technically demanding. As with other emerging technologies, improved surgeon education and training are needed.

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