Indian Spine Journal

Ethical issues while reporting in scientific journals Manish Chadha, Anil K Jain Indian Spine Journal 2020 3(1):1-3

Fundamentals of minimally invasive spine surgery Louis Chang, Sertac Kirnaz, Juan Del Castillo-Calcaneo, Ibrahim Hussain, Roger Härtl Indian Spine Journal 2020 3(1):4-10 Minimally invasive spine surgery (MISS) is a set of techniques and procedures that aims to minimize local tissue damage while achieving the same goals of traditional open surgery. In this article, we will provide a brief synopsis of the current state of MISS including its advantages over open surgery and its limitations. We will also describe basic techniques and essential tools needed to perform MISS effectively. As such, we have identified six interrelated fundamental principles to achieve success in MISS. They are the six Ts: Target, Technology, Technique, Training/Teaching, Testing, and Talent.

Expanding the horizons of minimally invasive spine surgery Arvind G Kulkarni, Tushar S Kunder, Swaroop Das, Sandeep Tapashetti Indian Spine Journal 2020 3(1):11-25 The trend of using smaller operative corridors is observed in various surgical specialties. The development of smart technologies with the overall aim of reducing surgical trauma has resulted in the concept of minimally invasive surgical techniques. Enhancements in microsurgery, tubes, endoscopy, and various percutaneous techniques, as well as improvement of implant materials, have proven to be milestones. The ease of performing surgery through tubes has recently evolved into percutaneous placement of spinal instrumentation, including intervertebral spacers, rods, and pedicle screws. The advancement of training of spine surgeons and the integration of image guidance with precise intraoperative imaging, computer-, and navigation-assisted treatment modalities constitute the era of reducing treatment morbidity in spinal surgery. This progress has led to the present era of preserving spinal function. In this report, we present a chronological perspective of the use of tubular retractors, the learning curve of tubular retractor in dealing complex cases and its wide applications, and expanding the horizon using tubular retractors.

A review of minimally invasive techniques for correction of adult spine deformity Aniruddh Agrawal, Neel Anand, Anisha Agrawal Indian Spine Journal 2020 3(1):26-33 This paper highlights the current status of minimally invasive surgery (MIS), with special attention to learning curve, cost-effectiveness, and different techniques, for the correction of adult spine deformity (ASD). A literature review was performed through the PubMed database. Studies that fit the inclusion criteria (n = 27) were analyzed by the authors through the MINORS criteria and their results were then presented. The abundance of data on the learning curve of the procedure shows that it takes at least 22–39 surgeries for a surgeon to reach optimal operative time. The literature search showed that there is a paucity of data available on the cost-effectiveness of the procedure in developing countries; however, if the results from the developed countries were to be considered, MIS is cost-effective for ASD correction. There are certain limitations to the procedure including inadequate sagittal balance as well as chances of proximal junctional kyphosis and adjacent segment disease; however, the overall benefits of MIS including decreased operative time, blood loss, and hospital stay could tilt the balance in its favor.

Complications and limitations of tubular retractor system in minimally invasive spine surgery: A review Amit C Jhala, Sharvil C Gajjar Indian Spine Journal 2020 3(1):34-40 The aim of a minimally invasive spine surgery is to decrease the collateral damage to the surrounding soft tissue, while performing the same task as that of a conventional open spine surgery. With widening of applications of the tubular retractor system, complications are prone to occur while performing surgery using tubular retractors. The aim of this review was to assess the spectrum of complications that are associated with tubular access spine surgery. A systematic review in English language literature on PubMed for clinical outcomes or complications in minimally invasive spine surgery using tubular retractors was carried out. A total of 11 articles were filtered from 2010 to 2018. Articles that were excluded were those with focus on open spine surgery, surgeries without using tubular retractors, Destandau technique, and endoscopic spine surgeries. The studies were divided into discectomy, decompressions, and fusions. Overall complications that were observed in the review were incidental durotomy, neurodeficits, infection, instability, reherniation, implant malposition, pulmonary embolism, hematoma, and urinary retention. The manifold advantages that are offered by the tubular retractor system include decreased iatrogenic tissue damage, decreased probability of surgical wound infections, decreased chances of instability, and rapid ambulation of the patients, providing an impetus to the number of day care procedures being performed for spine conditions. The complication profile in this review is comparable to the open spine surgeries except the risk of higher radiation hazard in minimally invasive transforaminal lumbar interbody fusion surgery but more high-quality randomized studies are required.

Current status of full-endoscopic spine surgery in cervical spine: Anterior and posterior approach Sagar B Sharma, Jin-Sung Luke Kim, Naveen D Siddappa, Hussam E Jabri Indian Spine Journal 2020 3(1):41-53 The techniques for the treatment of cervical disc herniation and cervical myelopathy have evolved over the last two decades. Anterior cervical decompression and fusion has been considered to be the gold standard technique to date. Recently, it has been shown that full-endoscopic spine surgery with upgraded technology and instrumentation has the capability to decompress the exiting nerve root and thecal sac effectively in the cervical spine. Good clinical outcomes have been reported in the literature with endoscopic procedures. The full-endoscopic spine technique can be an alternative to avoid interbody fusion surgeries. Successful decompression under constant visualization with a small incision and minimal surgical trauma can be achieved. There are two percutaneous endoscopic cervical spine approaches: anterior and posterior. Decision-making depends on anatomical and pathological considerations. Attaining full-endoscopic cervical spine technique requires a steep learning curve, practical training under the experts, and proper selection of patients. The recent developments related to endoscopic equipment with the availability of better optics, three-dimensional monitors, lighting systems, and newer generation endoscopes have made these techniques applicable in complex surgeries as well. The objective of this review was to provide a technical description of full-endoscopic anterior and posterior cervical spine surgeries and their current status in management of various cervical spine pathologies.

Transforaminal endoscopic surgery in lumbar spine: Technical aspects, current status, and evolving scope Arun Bhanot, Pradyumna P Raiturker, Abhishek Kashyap, Meenakshi Arora Indian Spine Journal 2020 3(1):54-65 Study Design: This study is comprehensive literature review. Aims and Objectives: This study aimed to evaluate the effectiveness of transforaminal endoscopic technique for managing symptomatic lumbar disc herniations and foraminal/extraforaminal/lateral recess stenosis and to assess the comparative status vis-à-vis existing treatment methods. Materials and Methods: A comprehensive systematic literature search of PubMed, Embase, and Cochrane library databases was performed for articles, including case series, randomized controlled trials (RCTs), controlled clinical trials (CCTs), reviews, and metanalysis with the following search terms: transforaminal endoscopic disc surgery, full endoscopic transforaminal surgery, selective endoscopic discectomy, percutaneous endoscopic lumbar discectomy, transforaminal endoscopic surgery for lumbar stenosis, and endoscopic surgery for foraminal stenosis in various combinations. Results: Results were analyzed in terms of efficacy, safety, complications, recurrence rate, and learning curve in comparison with standard preexisting open procedures. Overall, the reviewed literature pointed toward the following observations: the endoscopic techniques had shorter operating times, less blood loss, less operative site pain, faster postoperative rehabilitation, shorter hospital stay, faster return to work than the microsurgical techniques, although some of the observations were limited in their scope. Endoscopic foraminal stenosis decompression could help avoid facetectomy and fusion procedures. Conclusion: Full endoscopic transforaminal surgeries for lumbar disc herniations and foraminal stenosis are safe and effective alternative to open surgery. Similar clinical outcomes as compared with conventional open surgeries can be reached with lesser incidence of complications and better opportunities for revision surgeries, if and when needed.

Full-endoscopic interlaminar surgery of lumbar spine: Role in stenosis and disc pathologies Pramod V Lokhande Indian Spine Journal 2020 3(1):66-77 The aim of this study was to evaluate the effectiveness of full-endoscopic interlaminar operations for symptomatic lumbar disc herniations and lumbar canal stenosis and to compare their results with conventional open procedures. A comprehensive systematic literature search of PubMed, Embase, and Cochrane Library databases was performed for articles, including randomized trials (RCTs), controlled clinical trials (CCTs), reviews, and meta-analysis with the following search terms: full-endoscopic discectomy, also known as percutaneous endoscopic lumbar discectomy, interlaminar discectomy, endoscopic, and percutaneous stenosis decompression in various combinations. Results were analyzed for their effectiveness, safety, complications, recurrence rate, and learning curve, and compared with standard open procedures. Overall, the endoscopic techniques had shorter operating times, less blood loss, less operative site pain, and faster postoperative rehabilitation/shorter hospital stay/faster return to work than the microsurgical techniques for both disc herniation and lumbar spinal stenosis surgeries. The advantages and disadvantages of variations in techniques and choice of anesthesia are discussed. This comprehensive literature review shows that full-endoscopic surgeries for lumbar disc herniations and lumbar spinal stenosis are safe and effective alternative to open surgery. These can achieve the same clinical results with added benefits of minimally invasive spine surgeries.

Complications and limitations of endoscopic spine surgery and percutaneous instrumentation Hyeun-Sung Kim, Sagar B Sharma, Pang Hung Wu, Harshavardhan D Raorane, Nitin M Adsul, Ravindra Singh, Il-Tae Jang Indian Spine Journal 2020 3(1):78-85 Endoscopic spine surgery has started replacing conventional microdiscectomy in various centers across the globe. With development in the field of optics and instrumentation, the field of percutaneous endoscopic spine surgery has evolved immensely. With increasing experience, endoscopic spine surgeons have expanded the indications not only to lumbar paramedian disc herniations but also to central disc herniations, high-grade migrated disc herniations, sequestered herniations, thoracic and cervical disc herniations, and more recently, lumbar canal stenosis. With broadening indications, unexpected adverse events are bound to increase. Hence, it is essential for the endoscopic spine surgeons to be aware of the potential hazards and unexpected complications of the procedure so that appropriate care is taken to avoid adverse events as much as possible. In this article, we summarize all the complications of transforaminal endoscopic discectomy reported in the literature. We have classified the complications into intraoperative, immediate postoperative, and late postoperative complications. The senior author has also suggested the tips to avoid these complications and carry out the procedure as safely as possible. As percutaneous instrumentation, particularly, percutaneous pedicular screws, is also becoming common with the development of minimally invasive spine surgery, we have also summarized its complications and limitations. An insight into these complications will help the endoscopic surgeons to take special precautions when performing the procedure.

Illustrative case of multiple-level oblique lumbar interbody fusion (OLIF) Niraj B Vasavada, Prateek P Lodha Indian Spine Journal 2020 3(1):86-90 We report the case of an 80-year old man who presented with nonischemic neurogenic claudication having predominantly right leg radiating pain. Magnetic resonance imaging confirmed it as a case of multiple level lumbar canal stenosis (L2-3, L3-4, L4-5) with right sided de-novo lumbar scoliosis. The patient underwent multiple-Level Oblique Lumbar Interbody Fusion (OLIF) with good clinical outcomes.