Neurosurgery
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The transforaminal lumbar interbody fusion remains one of the most common surgical techniques used for spinal arthrodesis. Spine surgery over the last three decades has increasingly emphasized approaches that reduce tissue trauma, iatrogenic injury, and perioperative morbidity. ⋯ In this paper, the authors review the techniques and considerations underlying visualization within both methods, as well as provide summary of a hybrid system incorporating the advantages of both. Minimally invasive transforaminal lumbar interbody fusion modalities must be selected in accordance with patient factors to achieve optimal outcomes.
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Symptomatic thoracic disc herniation (TDH) is relatively uncommon, and surgical management poses significant challenges owing to restricted anatomic corridors, limited space within the spinal canal, tenuous blood supply, and proximity to vital organs and vasculature. Calcified TDH adds further complexity, necessitating meticulous preoperative planning to determine the safest and most effective approach. ⋯ However, research specifically focusing on the efficacy of this technique remains limited. This narrative review examines the existing literature on the lateral retropleural approach, discussing reported outcomes, technical considerations, and potential challenges.
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Robotic-assisted spine surgery has significantly advanced surgical precision and safety. This is particularly pertinent in minimally invasive spine surgeries that rely on imaging and technologies for visualization and the ability to accomplish surgical goals through smaller surgical corridors. The ability to preoperatively plan and then place pedicle screws across a wide range of applications has reduced the difficulty of even complex surgeries that once may have been considered prohibitive for minimally invasive approaches. While challenges and limitations remain, ongoing research and development aim to address these to continually expand the benefits of robotic-assisted spine surgery.
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Thoracolumbar minimally invasive spine surgery (MIS) has become widely adopted over the past two decades. MIS cervical fixation has lagged behind, largely because of complex and variable cervical spinal anatomy. Traditional open spine fixation techniques are associated with high fusion rates but are plagued by significant approach-related morbidity. ⋯ With the incorporation of new enabling navigation technologies, this technique is feasible, reproducible, and safe. In addition, these procedures have provided unique solutions for approaching cervical pathology in line with currently accepted MIS principles of the thoracolumbar spine. This review article discusses current minimally invasive posterior fusion strategies with a description of the technique and case demonstrations.
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Although the value of patient-reported outcomes (PROs) regarding assessing patient and quality-of-care outcomes is increasingly recognized within spine surgery, the benefits and challenges associated with the collection and clinical use of PROs remain to be established. The aim of this review was to discuss the published evidence on the wealth of clinically relevant data provided by PRO measures within spine surgery. ⋯ Physician-reported outcomes are often unable to provide a comprehensive evaluation of clinical and quality-of-care outcomes within spine surgery. Incorporation of PROs in patient evaluation is an integral part of efforts aimed at achieving excellence in health care delivery, as PROs help gain insight into individual patients' experiences and integrate an appraisal of patients' perspectives into clinical practice.