2023 Volume 32 Issue 5 Pages 300-308
The technology of minimally-invasive surgery (MIS) provides many surgical options for lumbar degenerative diseases (LDD). Indication of each method should be determined according to the patient's condition.
Microscopic posterior decompression is commonly used by neurosurgeons. This should be primarily considered for LDD. Neural tissues in the spinal canal of vertebral foramen are decompressed by partial laminectomy and facetectomy. Concurrently, the posterior structure must be preserved sufficiently for spinal stability, which is made possible by MIS. The same surgical intervention can be performed in endoscopy-assisted surgeries using tubular retractors.
Full-endoscopic spinal surgery is another MIS option. An endoscope is introduced into the interlaminar space or intervertebral foramen without dissecting the soft tissues. Surgical manipulation is performed under continuous irrigation. This method is technically difficult and requires a relatively long time to master.
MIS enables easier lumbar interbody fusion (IBF) surgery. In posterior/transforaminal lumbar IBF, neural tissues are decompressed with laminectomy and facetectomy, and local bone is grafted with interbody cages. In anterior/lateral lumbar IBF (ALIF/LLIF), surgical manipulations are performed via the retroperitoneal approach without injuring the posterior spinal structures. ALIF is often used to treat discogenic pain and kyphotic deformities. However, this method has been utilized only by certain surgeons because it often requires manipulation of major vessels. LLIF is more readily available because of its surgical manipulation using dedicated devices, sparing the major vessels. As a larger cage can be placed between the bilateral edges of the intervertebral space, LLIF has the advantage of correcting scoliosis. However, this method is incapable of direct neural decompression and expects only indirect neural decompression secondary to the restoration of the intervertebral height. MIS-posterior instrumentation is often used in IBF surgeries to promote a higher rate of arthrodesis and early return to daily living.
