Minimally invasive spine instrumentation.

OBJECTIVE: We discuss the instrumentation used with minimally invasive spine surgery.

METHODS: Minimally invasive surgery has revolutionized all areas of surgery. The use of endoscopes permits surgical maneuvers to be performed through small incisions.

RESULTS: Video-assisted thoracoscopic surgery can be used for a variety of spinal indications. The nerve roots and the spinal cord can be decompressed, bone grafts can be placed for interbody fusion and vertebral body reconstruction, and internal fixation devices can be applied to stabilize the spine. Thoracoscopy can be used to perform thoracic sympathectomies, to resect thoracic disk herniations, to biopsy thoracic vertebral body lesions, to release complex spinal curvatures for the reduction of scoliosis, to perform vertebrectomies, to resect tumors, to debride infections, and to treat spinal fractures. Laparoscopic techniques have been applied to the lumbar spine. Laparoscopic procedures have been used for anterior and posterior approaches to the lumbar spine. Anterior arthrodesis has been performed by laparoscopic insertion of the Bagby and Kuslich cages into the L4-5 and the L5-S1 intervertebral disc spaces. Laparoscopic retroperitoneal techniques have been used for anterior plating to fixate the anterior column rigidly to restore stability. In addition, the posterolateral approach has been used for pedicle screw fixation of the lumbar spine using endoscopic techniques.

CONCLUSION: Minimally invasive techniques have been used successfully for treating spinal disorders. With the use of endoscopic techniques, a spine surgeon can perform complex spinal instrumentation through small portals, thus reducing morbidity for the patient.