The object of the study was to review the author’s large series of minimally invasive spine surgeries for complication rates. The author reviewed a personal operative database for minimally access spine surgeries done through nonexpandable tubular retractors for extradural, nonfusion procedures. Consecutive cases ( ) were reviewed for complications. There were no wound infections. Durotomy occurred in 33 cases (2.7% overall or 3.4% of lumbar cases). There were no external or symptomatic internal cerebrospinal fluid leaks or pseudomeningoceles requiring additional treatment. The only motor injuries were 3 C5 root palsies, 2 of which resolved. Minimally invasive spine surgery performed through tubular retractors can result in a low wound infection rate when compared to open surgery. Durotomy is no more common than open procedures and does not often result in the need for secondary procedures. New neurologic deficits are uncommon, with most observed at the C5 root. Minimally invasive spine surgery, even without benefits such as less pain or shorter hospital stays, can result in considerably lower complication rates than open surgery. 1. Introduction Minimal access spinal surgery is a rapidly developing set of techniques, which have compared favorably with open surgeries in the recent literature (see review in Wong et al., 2012) [1–4]. In addition to reduced blood loss, shorter operative time, reduced postoperative pain, earlier discharge, rapid return to normal activities, and other reported advantages of minimally invasive surgery, [5] a decreased complication rate associated with these surgeries has also been noted, particularly with respect to wound infections [6]. The author reports experience on management of a large series of minimally invasive spine procedures. 2. Methods 2.1. Patient Population The author began using the Metrx Tubular Retraction System (Medtronic, Minneapolis) in 2001. This report constitutes a retrospective review of all consecutive spine cases done using this system from that time to the present. Information was obtained from the author’s personal surgeries database. This report does not include intentionally intradural procedures or fusion procedures. This series does not include the use of expandable tubes or other minimal access retractor systems other than a tubular system. Procedures reported here were for laminectomy and/or foraminotomy for spondylotic diseases such as discectomy or stenosis, for epidural masses such as metastases, abscesses, or synovial cysts, or for spinal cord stimulator paddle electrode implantation.
References
[1]
C. D. Lawton, Z. A. Smith, S. K. Lam, A. Habib, R. H. Wong, and R. G. Fessler, “Clinical outcomes of microendoscopic foraminotomy and decompression in the cervical spine,” World Neurosurgery, vol. 81, no. 2, pp. 422–427, 2014.
[2]
P. Lee, J. C. Liu, and R. G. Fessler, “Perioperative results following open and minimally invasive single-level lumbar discectomy,” Journal of Clinical Neuroscience, vol. 18, no. 12, pp. 1667–1670, 2011.
[3]
Z. A. Smith and R. G. Fessler, “Paradigm changes in spine surgery-evolution of minimally invasive techniques,” Nature Reviews Neurology, vol. 8, no. 8, pp. 443–450, 2012.
[4]
A. P. Wong, Z. A. Smith, R. R. Lall, L. E. Bresnahan, and R. G. Fessler, “The microendoscopic decompression of lumbar stenosis: a review of the current literature and clinical results,” Minimally Invasive Surgery, vol. 2012, Article ID 325095, 11 pages, 2012.
[5]
P. Shih, A. P. Wong, T. R. Smith, A. I. Lee, and R. G. Fessler, “Complications of open compared to minimally invasive lumbar spine decompression,” Journal of Clinical Neuroscience, vol. 18, no. 10, pp. 1360–1364, 2011.
[6]
J. E. O'Toole, K. M. Eichholz, and R. G. Fessler, “Surgical site infection rates after minimally invasive spinal surgery: clinical article,” Journal of Neurosurgery: Spine, vol. 11, no. 4, pp. 471–476, 2009.
[7]
R. M. Haque, S. Z. Hashmi, Y. Ahmed, O. Uddin, A. T. Ogden, and R. Fessler, “Primary dural repair in minimally invasive spine surgery,” Case Reports in Medicine, vol. 2013, Article ID 876351, 6 pages, 2013.
[8]
M. A. Olsen, J. J. Nepple, K. D. Riew et al., “Risk factors for surgical site infection following orthopaedic spinal operations,” Journal of Bone and Joint Surgery, vol. 90, no. 1, pp. 62–69, 2008.
[9]
M. A. Olsen, J. Mayfield, C. Lauryssen et al., “Risk factors for surgical site infection in spinal surgery,” Journal of Neurosurgery, vol. 98, no. 2, pp. 149–155, 2003.
[10]
K. Ikuta, O. Tono, T. Tanaka et al., “Surgical complications of microendoscopic procedures for lumbar spinal stenosis,” Minimally Invasive Neurosurgery, vol. 50, no. 3, pp. 145–149, 2007.
[11]
T. K. Hunt and H. W. Hopf, “Wound healing and wound infection: what surgeons and anesthesiologists can do,” Surgical Clinics of North America, vol. 77, no. 3, pp. 587–606, 1997.
[12]
V. M. Bhalodia, D. M. Schwartz, and A. K. Sestokas, “Efficacy of intraoperative monitoring of transcranial electrical stimulation-induced motor evoked potentials and spontaneous electromyography activity to identify acute-versus delayed-onset C-5 nerve root palsy during cervical spine surgery: clinical article,” Journal of Neurosurgery: Spine, vol. 19, no. 4, pp. 395–402, 2013.
[13]
D. Lubelski, A. Derakhshan, A. S. Nowacki et al., “Predicting C5 palsy via the use of preoperative anatomic measurements,” The Spine Journal, 2013.
[14]
S. Takenaka, N. Hosono, Y. Mukai, T. Miwa, and T. Fuji, “The use of cooled saline during bone drilling to reduce the incidence of upper-limb palsy after cervical laminoplasty: clinical article,” Journal of Neurosurgery: Spine, vol. 19, no. 4, pp. 420–427, 2013.
[15]
D. K. Hamilton, J. S. Smith, C. A. Sansur et al., “Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the scoliosis research society morbidity and mortality committee,” Spine, vol. 36, no. 15, pp. 1218–1228, 2011.
[16]
Y. Takahashi, T. Sato, H. Hyodo et al., “Incidental durotomy during lumbar spine surgery: Risk factors and anatomic locations: Clinical article,” Journal of Neurosurgery: Spine, vol. 18, no. 2, pp. 165–169, 2013.
[17]
A. Desai, P. A. Ball, K. Bekelis et al., “SPORT: does incidental durotomy affect long-term outcomes in cases of spinal stenosis?” Neurosurgery, vol. 69, no. 1, pp. 38–44, 2011.
[18]
S. I. Tafazal and P. J. Sell, “Incidental durotomy in lumbar spine surgery: Incidence and management,” European Spine Journal, vol. 14, no. 3, pp. 287–290, 2005.
