European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Less invasiveness is the way forward for spinal surgery. Minimal disruption of tissue, preservation of muscle function, and restoration of normal spinal alignment are still the goals of most surgical procedures. ⋯ The autograft is harvested from the vertebral body, thus avoiding the morbidity associated with an iliac crest bone graft. The operative steps for the procedure are described.
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The most readily available source for autologous bone graft used in spinal fusion (the gold standard) is the iliac crest. However, the open surgical approach for harvesting corticocancellous iliac bone is associated with a marked increase in morbidity. This study suggests two alternatives to the traditional open harvesting procedure. ⋯ Regional bone graft harvest in anterior spine surgery is suggested to be anatomically safe and biomechanically acceptable. Any of the three filler materials can restore the vertebral body's mechanical strength, but the filler's long-term resorption/remodeling or osteointegration behavior is unknown. The minimally invasive bone graft harvester is a novel tool, which performed satisfactorily under laboratory conditions, but clinical results are still missing.
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The terms 'minimally invasive' or 'less invasive surgery' have been used recently to describe surgical approaches or operations that are performed with less trauma to anatomical structures on the way to or surrounding the surgical 'target area'. These types of surgical procedures are usually performed with the help of 'high-tech' instruments such as surgical endoscopes or surgical microscopes, modern video techniques and automated instruments. Within the last 10 years, such techniques have been developed in the field of spinal surgery. ⋯ Through small (4-cm) skin incisions, the target area can be exposed. Preliminary results suggest decreased peri - and postoperative morbidity, less blood loss, earlier rehabilitation and acceptable complication rates. The technique is currently used by the author for all patients requiring anterior lumbar interbody fusion.
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Eighty consecutive cases of suprafascial pedicle screw stabilization were reviewed. Intraoperative fluoroscopy aided the percutaneous screw placement after structural anterior interbody graft(s) were placed. During routine outpatient hardware removal, all intradiscal fusions were stressed via the Shanz screws under fluoroscopy. Anterior reconstruction via a mini open approach coupled with this minimally invasive posterior approach led to a 96% successful fusion rate.
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Transarticular C1/2 screws are widely used in posterior cervical spine instrumentation. The use of pedicle screws in the cervical spine remains uncommon. Due to superior biomechanical stability compared to lateral mass screws, pedicle screws can be used, especially for patients with poor bone quality or defects in the anterior column. ⋯ Therefore, this technique may be used in a clinical setting, as it offers improved accuracy and reduced radiation dose for the patient and the medical staff. Nevertheless, users should take note of known sources of possible faults causing inaccuracies in order to prevent iatrogenic damage. Small pedicles, with a diameter of less than 4.0 mm, may not be suitable for pedicle screws.