What is the Lumbar Minimally Invasive Surgery

    With the rapid development of minimally invasive surgical techniques for lumbar spine, the minimally invasive surgical methods are evolving rapidly. Different methods of minimally invasive lumbar spine surgery can treat various diseases including lumbar disc herniation, lumbar spinal stenosis, lumbar degenerative spondylolisthesis or isthmic spondylolisthesis, degenerative lumbar Or idiopathic scoliosis, lumbar instability, lumbar infection, lumbar tuberculosis, lumbar spinal canal tumors and other types of lumbar disease. In other words, lumbar minimally invasive surgery can be used to treat almost all lumbar disorders.

    Minimally invasive surgery due to trauma, fast recovery and other advantages is easy to accept for the people, but there is a certain degree of risk of lumbar surgery, whether surgery really need to be cautious, but not as dangerous as the legend of the people, the success rate of surgery is high. If you really do one out of a problem, without patient complaints, we have long since done. Personally think that the choice of a good doctor, the risk of lumbar surgery is similar to the risk of flying, the chance of a problem is not large, but not without problems.

    In general, lumbar surgery can be minimally invasive surgical approach, but each minimally invasive surgical approach has some indications and contraindications, in other words, each patient requires minimally invasive treatment have Different. This needs to be based on the condition of the illness, the condition of the hospital, the experience and ability of the doctor.

    So minimally invasive surgery which way? What kind of minimally invasive treatment should I choose the best?

    There are many ways of minimally invasive surgery, I can only cite some commonly used minimally invasive surgical methods for your reference.

    (1) percutaneous nuclear nucleus chemical lysis, percutaneous discectomy, percutaneous laser disc ablation, percutaneous nucleoplasty, percutaneous ozone ablation. See so many names, you must be dizzy. In fact, the basic principle of so many surgical methods is the same. Is under X-ray, from the rear or lateral rear puncture to the lumbar intervertebral disc, with chemical drugs, laser, ozone, low temperature plasma ablation and other methods to reduce intradiscal pressure or remove part of the disc tissue, in order to achieve the purpose of nerve root decompression .

    Indications and benefits: Discography confirmed as young, inclusive disc herniation, with a significantly smaller prominent patient; or discogenic low back pain. The wound is the needle point of the needle, so the trauma is very small. Almost immediately after surgery can be normal activities.

    Contraindications and Disadvantages: Operators should not look under the operation of the operation, can not see the nerve tissue, so the greater the possibility of damage to the nerves. Doctors can only under CT or X-ray puncture and to do interbody fusion disc or disc resection, it is difficult to completely decompression. Does not apply to lumbar spondylolisthesis, lumbar spinal stenosis, lumbar disc herniation, or nucleus into the spinal canal, disc and posterior longitudinal ligament calcification, and the emergence of abnormalities of the cauda equina syndrome. Foreign scholars reported the overall efficiency of surgery is not high, but the strict selection of indications based on the surgical efficacy is acceptable.

    (2) under the intervertebral disc discectomy: this operation with the previous disc puncture in parallel with the basis of discography, an increase of surgical endoscopy system, surgical incision 0,7cm or so, the doctor can endoscopic surveillance, Identify and remove the disc to relieve oppression; intraoperative continuous saline flushing can clear intradiscal toxic metabolites, pain and inflammatory mediators. With the gradual improvement of technology, the current intervertebral foramen through intervertebral foramen, interlaminal space into the endoscopic system, the disc removed. Indications and advantages: suitable for lumbar disc herniation, simple disc herniation, no intervertebral disc and calcification of the posterior longitudinal ligament. Intraoperative almost no damage to the lumbar spine, paravertebral muscles and ligaments, less bleeding, postoperative recovery faster.

    Contraindications and shortcomings: surgical operation is difficult, long learning time. Surgery requires repeated X-ray to determine the puncture is correct. Narrow vision, sometimes difficult to completely remove the prominent disc tissue. Not suitable for lumbar spondylolisthesis, lumbar instability, lumbar infection, cancer and deformity, disc and PCL calcification, and the emergence of abnormalities of the cauda equina syndrome.

    3) disc disc discectomy: This surgical approach using the traditional posterior approach to establish the working channel up to the interlaminar space, in the endoscopic microsurgical removal of prominent disc tissue, and for the same side of the crypt and nerve root Tube decompression. The company is located in:

    Indications and advantages: suitable for lumbar disc herniation, lumbar spinal stenosis patients. The advantage is the traditional surgery based on further protection of the spinal stability and waist muscles. Wider than the previously described surgical approach, clear vision, safe operation. Surgical incision 2cm. Quick recovery after surgery.

    Indications and advantages: suitable for lumbar disc herniation, lumbar spinal stenosis patients. The advantage is the traditional surgery based on further protection of the spinal stability and waist muscles. Wider than the previously described surgical approach, clear vision, safe operation. Surgical incision 2cm. Quick recovery after surgery. The company is located in:

Contraindications and disadvantages: The technical requirements of surgery are relatively high. Not suitable for lumbar spondylolisthesis, lumbar instability, lumbar infection, cancer and deformity, disc and PCL calcification, and the emergence of abnormalities of the cauda equina syndrome.

(4) minimally invasive interbody fusion

The three methods mentioned above can not be used to treat lumbar spondylolisthesis, lumbar fractures, lumbar instability, lumbar infections, tumors and deformities. For such patients, the current minimally invasive percutaneous pedicle screw fixation, spinal decompression and interbody fusion. The traditional posterior median approach adopted in traditional lumbar fixation has the disadvantages of long incision, large damage and slow recovery. Especially for multi-segmental lumbar surgery, extensive muscle dissection often leads to muscle atrophy and fibrosis, which often leads to postoperative lumbar weakness , Pain and discomfort. Percutaneous stapling allows placement of pedicle screws with minimal damage within a 1,5 cm incision without stripping muscle tissue; minimally invasive channel decompression of the spinal canal requires less surgical incisions than conventional surgical incisions Single-section surgical incision only about 3cm), due to the operation of the intramuscular approach, so there is no need for a wide range of muscle tissue stripping; minimally invasive screw + minimally invasive surgical approach can be achieved with minimal surgical trauma to complete Spinal decompression, intervertebral bone graft and lumbar fixation. The surgical trauma, less bleeding, postoperative pain relief, fast recovery, hospitalization time is short, both for young patients or elderly patients are extremely applicable.

(5) minimally invasive lumbar lateral peritoneal fusion

This surgical approach is relatively new in recent years, surgical procedures, despite a certain degree of surgical efficacy, but due to the reasons for the greater number of lateral lumbar spine, there is a certain risk of surgery, though with the help of nerve monitor surgery , The initial development of the surgical approach still appeared more neurological injury complications. With the continuous improvement of this surgical method in recent years, the safety is gradually improved, and surgical indications are gradually widespread. The surgical indications include: lumbar degenerative diseases, lumbar spinal stenosis, lumbar degenerative scoliosis, congenital and idiopathic scoliosis, lumbar degenerative instability, anterograde fusion based on posterior decompression, lumbar spine Revision surgery (pseudarthrosis, ASD, etc.), lumbar disc replacement and revision, thoracic disc herniation, thoracolumbar fractures, thoracolumbar infection, thoracolumbar tumors.