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Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis.

Sarwahi V, Amaral T, Wendolowski S, Gecelter R, Gambassi M, Plakas C, Liao B, Kalantre S, Katyal C - Biomed Res Int (2015)

Bottom Line: However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients.We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis.Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Orthopedics, Cohen Children's Medical Center, New Hyde Park, NY 11040, USA.

ABSTRACT
Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

No MeSH data available.


Related in: MedlinePlus

MRI axial image of the lumbar spine with the block arrow pointing to the facet joint, which is the most prominent area after the spinous process and is easily palpable after the lumbar fascia is incised. The thin arrow denotes the plane of dissection between multifidus medially (M) and longissimus laterally (L). This plane is approximately 2 to 2.5 cm lateral to the midline.
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fig2: MRI axial image of the lumbar spine with the block arrow pointing to the facet joint, which is the most prominent area after the spinous process and is easily palpable after the lumbar fascia is incised. The thin arrow denotes the plane of dissection between multifidus medially (M) and longissimus laterally (L). This plane is approximately 2 to 2.5 cm lateral to the midline.

Mentions: The skin is undermined and mobilized on either side of midline to allow for the placement of pedicle screws on both sides. The muscle dissection is started in the lumbar spine, where the facet can be manually palpated. A stab incision in the fascia is made, directly over the facet, and muscle plane is developed bluntly between multifidus and longissimus coli with a Cobb elevator or an insulated electrocautery (Figures 2 and 3).


Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis.

Sarwahi V, Amaral T, Wendolowski S, Gecelter R, Gambassi M, Plakas C, Liao B, Kalantre S, Katyal C - Biomed Res Int (2015)

MRI axial image of the lumbar spine with the block arrow pointing to the facet joint, which is the most prominent area after the spinous process and is easily palpable after the lumbar fascia is incised. The thin arrow denotes the plane of dissection between multifidus medially (M) and longissimus laterally (L). This plane is approximately 2 to 2.5 cm lateral to the midline.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663285&req=5

fig2: MRI axial image of the lumbar spine with the block arrow pointing to the facet joint, which is the most prominent area after the spinous process and is easily palpable after the lumbar fascia is incised. The thin arrow denotes the plane of dissection between multifidus medially (M) and longissimus laterally (L). This plane is approximately 2 to 2.5 cm lateral to the midline.
Mentions: The skin is undermined and mobilized on either side of midline to allow for the placement of pedicle screws on both sides. The muscle dissection is started in the lumbar spine, where the facet can be manually palpated. A stab incision in the fascia is made, directly over the facet, and muscle plane is developed bluntly between multifidus and longissimus coli with a Cobb elevator or an insulated electrocautery (Figures 2 and 3).

Bottom Line: However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients.We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis.Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Orthopedics, Cohen Children's Medical Center, New Hyde Park, NY 11040, USA.

ABSTRACT
Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

No MeSH data available.


Related in: MedlinePlus