Jeffrey A. Goldstein, MD
The theory with any minimally invasive spine surgery system is that smaller incisions and percutaneous approach will create less tissue damage, less blood loss, shorter hospital stays and faster recovery. However, the advantages of any minimally invasive spine fusion system are still considered to be theoretical and have not yet been proven.
A minimally invasive spine fusion system is designed to allow placement of pedicle screws (into the pedicles on each side of the vertebral bone) and rods (which connect the screws) into the spine. These spine surgery systems use several small incisions in the skin, rather than one long incision, and the surgeon is guided by sophisticated imaging technology that projects the anatomical images onto a television screen. The theoretical advantage is that the screws and rods are placed into the bone in the spine with minimal trauma to the muscle and tendons in the back. See Figure 1, Figure 2, and Figure 3.
Foley et al. recently reported their experience with using a minimally invasive spinal fusion instrumentation system (the SEXTANT) in the Journal of Neurosurgical Focus. At an average follow-up of 6.8 months, eleven of twelve patients reported good to excellent results. This is a very small sample size, however, and the results of this study are comparable to the majority of published results for traditional open spine fusion surgery procedures (which generally show fusion rates over 90% and patient satisfaction with the procedure about 80 - 90% of the time).
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Minimally invasive alternatives to traditional fusion surgery are still very new. These systems involve a steep learning curve for the spine surgeon, and surgical times may initially increase when using a minimally invasive spine fusion system vs. a traditional, open spine fusion approach.
In addition to the type of technology or medical device used for a fusion, there are several important factors that influence the outcome of any spine fusion surgery, including the spine surgeon's skill and experience, indications for a spine fusion/patient selection, and the type of fusion and surgical technique that is used.