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Namath S. Hussain and Mick J. Perez-Cruet

W ith recent advances in technique and access instrumentation, minimally invasive spine surgery has ushered in a renaissance in spine care. Surgeons are becoming more comfortable with these procedures, and industry-surgeon collaborations have provided a plethora of new products to make surgery safer for patients and improve patient outcomes. As more patients receive minimally invasive spine surgery treatments, stronger long-term outcome data are supporting this change in practice pattern. 20 , 21 Patient outcomes are improved compared with traditional

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The evolution of minimally invasive spine surgery

JNSPG 75th Anniversary Invited Review Article

Jang W. Yoon and Michael Y. Wang

T he field of spinal surgery has advanced significantly over the past half century. Along with the proliferation of techniques and technologies in general, there has been a concomitant movement to reduce the morbidity of surgery. Minimally invasive surgical (MIS) approaches have thus been popularized, with its core principles being the following: 1) to minimize the collateral damage, 2) to preserve the normal anatomy, and 3) to reduce the overall stress to the patient, all while achieving the same surgical goals as open surgery. The roots in minimally invasive

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Harel Deutsch

Lumbar radiculopathy is a common problem. Nerve root compression can occur at different places along a nerve root's course including in the foramina. Minimal invasive approaches allow easier exposure of the lateral foramina and decompression of the nerve root in the foramina. This video demonstrates a minimally invasive approach to decompress the lumbar nerve root in the foramina with a lateral to medial decompression.

The video can be found here:

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John E. O'Toole, Kurt M. Eichholz and Richard G. Fessler

utilization dramatically and may worsen overall clinical outcomes. 6–8 , 34 , 42 , 50 Minimally invasive surgical techniques have been applied to spinal surgical cases for more than a decade now, 16 and anecdotal experience by the authors and others 20 has suggested a very low rate of SSI after MISS; precise rates of postoperative wound infections have not been specifically studied in the literature, however. We therefore sought to examine our cumulative experience with SSIs after MISS and compare these findings to the standard infection rates published for traditional

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Ulrich Hubbe, Pamela Franco-Jimenez, Jan-Helge Klingler, Ioannis Vasilikos, Christoph Scholz and Evangelos Kogias

S urgery for recurrent lumbar disc herniation (LDH) is accompanied by higher morbidity rate compared with primary herniation surgery. Epidural scar tissue increases the risk of dural tear and nerve root injury. 19 , 23 , 45 , 50 The majority of surgeons prefer the use of standard open microdiscectomy to treat recurrent LDH, 5 , 46 , 47 since wider exposure is assumed to provide for more convenient recognition of anatomical landmarks and tissue manipulation. The limited operating window of minimally invasive approaches has been regarded as a discouraging

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Marlin Dustin Richardson and Michael H. Handler

is a minimally invasive approach to the pleural space. Quick and simple, it has few complications and is a good alternative when the peritoneal space is inhospitable and entails fewer problems than use of a vascular terminus. Acknowledgement The authors would like to thank John Bealer, M.D., for initial discussions on development of the approach. Disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Author contributions to the study and manuscript

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Ravi H. Gandhi and John W. German

the entire facet was removed to reach the tumor. One patient required anterior cervical discectomy and fusion for degenerative disc disease, but this was to treat a preexisting condition. Although dynamic imaging was not customarily used in our series, no other patients required subsequent surgery for the treatment of instability or symptomatic kyphosis. In an attempt to further advance minimally invasive approaches to the spine, tubular retractors with muscles-plitting techniques have been applied to the treatment of intradural pathology. This minimizes muscle

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Sanjay S. Dhall, Rishi Wadhwa, Michael Y. Wang, Alexandra Tien-Smith and Praveen V. Mummaneni

A lthough minimally invasive techniques for spinal fixation have grown tremendously in popularity over the last several years, these techniques were originally described nearly 40 years ago. Magerl and Dick described the percutaneous placement of a spinal internal fixator in 1977 in nontraumatic cases. 3 Since that time, there have been several retrospective case series published on minimally invasive fixation techniques for spinal trauma, most notably the use of percutaneous pedicle screw fixation without fusion. 1 While mini-open approaches allow

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Domagoj Coric and Tim Adamson

degenerative disc disease adjacent to fusions. 20 These radiographic changes may lead to a higher incidence of symptomatic segmental degeneration, necessitating further fusion surgery. 9 , 29 Rates of symptomatic adjacent level degenerative disc disease range from 10 to 25%. 13 , 19 Recently, spine surgery has seen parallel interest and development in the areas of motion preservation and minimally invasive surgery. Spinal arthroplasty offers the practical advantage of preservation of motion as well as the theoretical benefit of decreased adjacent level surgery. 6 , 10

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Justin S. Smith, Alfred T. Ogden and Richard G. Fessler

Ultimately, these effects can lead to paraspinal muscle atrophy, scarring, and decreased extensor strength and endurance, and can contribute to increased postoperative and long-term pain. 24 , 35 , 46 , 48 , 52 , 60 , 61 , 69 , 79 In an effort to mitigate the morbidities associated with conventional open spine procedures, recent advances in minimal access technologies have led to the application of minimally invasive approaches to all regions of the spine for decompression, arthrodesis, and instrumentation. Until recently, the vast majority of advancements in minimally