minimally invasive spine surgery (miss)

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Minimally Invasive Spine Surgery (MISS) History and development KM SIEH Associate consultant Alice Ho Mui Ling Nethersole Hospital Venue HA Convention 2016 HA Convention Masterclass 3 rd May 2016

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Page 1: Minimally Invasive Spine Surgery (MISS)

Minimally Invasive Spine Surgery (MISS) History and development

KM SIEH Associate consultant

Alice Ho Mui Ling Nethersole Hospital

Venue HA Convention 2016

HA Convention Masterclass 3rd May 2016

Page 2: Minimally Invasive Spine Surgery (MISS)

Once upon a time……

U wanna die?

Page 3: Minimally Invasive Spine Surgery (MISS)

Concept of Minimally Invasive Surgery……

Cholecystectomy

Video assisted Thoracotomy

Minimally invasive spine surgery

Hey, we can!

?

Page 4: Minimally Invasive Spine Surgery (MISS)

How special is spine surgery?

There is no true cavity in the spine

Deep seated and surrounded by important organs and structure

Page 5: Minimally Invasive Spine Surgery (MISS)

How special is spine surgery?

Sophisticated global spine function

Safety

Page 6: Minimally Invasive Spine Surgery (MISS)

Development of MISS

Refined instrument

Image guidance Technology

Better Visualization

Page 7: Minimally Invasive Spine Surgery (MISS)

Improvement of visualization

Surgical microscope Surgical endoscope

Microdiscectomy Laproscopic

appendicectomy

Page 8: Minimally Invasive Spine Surgery (MISS)

Improvement of visualization

Spinal endoscope

Multiple working channel Refined micro-instrument

Page 9: Minimally Invasive Spine Surgery (MISS)

Soft tissue splitting technique

Dissection in open surgery Serial tubular dilator

Muscle ischemia

Dead space and scar

Muscle dysfunction

Pain

Prolonged retraction

Excessive removal of bone

Page 10: Minimally Invasive Spine Surgery (MISS)

Pedicle screws is the commonest instrumentation……

Image guidance technology

Misplacement of screws can be disastrous

Page 11: Minimally Invasive Spine Surgery (MISS)

Image guidance technology

Intraoperative X-ray CT- Flouro matching navigation

Page 12: Minimally Invasive Spine Surgery (MISS)

Image guidance technology

Intraoperative 3D CT

Screw insertion

Percutaneous screw insertion

Page 13: Minimally Invasive Spine Surgery (MISS)

Historical development of MISS….

Page 14: Minimally Invasive Spine Surgery (MISS)

Lumbar disc herniation

You suffer from

Sciatica la!

What’s wrong?

So painful!

Page 15: Minimally Invasive Spine Surgery (MISS)

Development of lumbar PID surgery

Hippocrates (460-370BC)

Mixter& Barr (1933)

Gazi Yasargil (1967)

Williams (1978)

Casper (1977)

Open Discectomy Microdiscectomy

Microendoscopic Discectomy (MED)

Foley & Smith (1997)

Destandau (1998)

Endospine

Page 16: Minimally Invasive Spine Surgery (MISS)

Hippocrates (460-370BC)

Mixter& Barr (1933)

Gazi Yasargil (1967)

Onik (1980)

Williams (1978)

Casper (1977)

Ascher and Choy (1986)

Open Discectomy Microdiscectomy

Microendoscopic Discectomy (MED)

Percut. Laser discectomy

Percut. Lumbar discectomy

Foley & Smith (1997)

Hijikata (1975)

Smith (1963)

Chemo- nucleolysis

Destandau (1998)

Endospine

Internal indirect decompression

Development of lumbar PID surgery

Page 17: Minimally Invasive Spine Surgery (MISS)

Hippocrates (460-370BC)

Mixter& Barr (1933)

Gazi Yasargil (1967)

Onik (1980)

Williams (1978)

Casper (1977)

Ascher and Choy (1986)

Open Discectomy Microdiscectomy

Microendoscopic Discectomy (MED)

Percut. Laser discectomy

Percut. Lumbar discectomy

Foley & Smith (1997)

Hijikata (1975)

Ruetten (2008)

Endoscopic Lumbar discectomy

Smith (1963)

Chemo- nucleolysis

Young (2002)

Kambin and Mayer(1993)

Destandau (1998)

Endospine

Full endoscopic discectomy

Interlaminar approach (GA) Posterolaterral approach (LA)

Development of lumbar PID surgery

Page 18: Minimally Invasive Spine Surgery (MISS)

Degenerative disc and back pain

One of the major source of back pain…..

Pain fibers at the periphery of the disc

Spinal fusion for those with failed conservative treatment

Page 19: Minimally Invasive Spine Surgery (MISS)

Degenerative disc and back pain

Result of spinal fusion is promising……

Surgical trauma with the exposure

Loss of motion segment

Page 20: Minimally Invasive Spine Surgery (MISS)

Degenerative disc and back pain

Prevent collapse of the disc space ……

Put ‘something’ back into the disc space - Acrylic - Glass - Bone cement - Metal

Pain and displacement

Later in the 90s - Silicone - Hydrogel - Synthetic polymer

Page 21: Minimally Invasive Spine Surgery (MISS)

Degenerative disc and back pain

Cooking ideas……

Heat will denature the protein

Intradiscal Electrothermal (IDET) Annulolasty

Page 22: Minimally Invasive Spine Surgery (MISS)

Degenerative disc and back pain

MISS in Spinal fusion

Highly specialized retractor for lumbar interbody fusion Percutaneous screw insertion

under image guidance

Page 23: Minimally Invasive Spine Surgery (MISS)

History and development of MISS……

MISS is unique and special……

Page 24: Minimally Invasive Spine Surgery (MISS)

History and development of MISS……

Patients are becoming more informed…..

Doc, how

to choose ?

Page 25: Minimally Invasive Spine Surgery (MISS)

Thank you

Any questions?