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Ten-Step Minimally Invasive Spine Lumbar Decompression and Dural Repair Through Tubular Retractors.

TitleTen-Step Minimally Invasive Spine Lumbar Decompression and Dural Repair Through Tubular Retractors.
Publication TypeJournal Article
Year of Publication2017
AuthorsBoukebir MAbdelatif, Berlin CDavid, Navarro-Ramirez R, Heiland T, Schöller K, Rawanduzy C, Kirnaz S, Jada A, Härtl R
JournalOper Neurosurg (Hagerstown)
Volume13
Issue2
Pagination232-245
Date Published2017 04 01
ISSN2332-4260
KeywordsDecompression, Surgical, Female, Follow-Up Studies, Functional Laterality, Humans, Lumbar Vertebrae, Male, Minimally Invasive Surgical Procedures, Neurosurgical Procedures, Postoperative Complications, Spinal Stenosis, Synovial Cyst, Treatment Outcome, Valsalva Maneuver, Visual Analog Scale
Abstract

BACKGROUND: Minimally invasive spine (MIS) surgery utilizing tubular retractors has become an increasingly popular approach for decompression in the lumbar spine. However, a better understanding of appropriate indications, efficacious surgical techniques, limitations, and complication management is required to effectively teach the procedure and to facilitate the learning curve.

OBJECTIVE: To describe our experience and recommendations regarding tubular surgery for lumbar disc herniations, foraminal compression with unilateral radiculopathy, lumbar spinal stenosis, synovial cysts, and dural repair.

METHODS: We reviewed our experience between 2008 and 2014 to develop a step-by-step description of the surgical techniques and complication management, including dural repair through tubes, for the 4 lumbar pathologies of highest frequency. We provide additional supplementary videos for dural tear repair, laminotomy for bilateral decompression, and synovial cyst resection.

RESULTS: Our overview and complementary materials document the key technical details to maximize the success of the 4 MIS surgical techniques. The review of our experience in 331 patients reveals technical feasibility as well as satisfying clinical results, with no postoperative complications associated with cerebrospinal fluid leaks, 1 infection, and 17 instances (5.1%) of delayed fusion.

CONCLUSION: MIS surgery through tubular retractors is a safe and effective alternative to traditional open or microsurgical techniques for the treatment of lumbar degenerative disease. Adherence to strict microsurgical techniques will allow the surgeon to effectively address bilateral pathology while preserving stability and minimizing complications.

DOI10.1227/NEU.0000000000001407
Alternate JournalOper Neurosurg (Hagerstown)
PubMed ID28927213