Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

New Minimally Invasive Approach To Upper Lumbar Fusion Surgery Reduces Complication Risk

02.08.2004


Surgeons at the Cedars-Sinai Institute for Spinal Disorders describe in the August 1 issue of the journal Spine a minimally invasive approach that enables them to perform fusion surgery on the difficult-to-access upper lumbar region of the spine with a reduced risk of serious complications.

“Compared to previous options, this new approach is safer with respect to major blood vessels and abdominal organs,” said John J. Regan, M.D., co-director of the Institute. “The majority of patients experienced immediate improvement in their preoperative pain, and there were no vascular injuries or major complications.”

Minimally invasive procedures that employ thin instruments and laparoscopes with high-powered camera lenses typically result in shorter recoveries, less pain and lower risk of complications than open surgeries that require long incisions in the large muscles of the back. The preferred approach is from the front or side, sparing the back muscles entirely and positioning instruments at the forward edge of the spine where the placement of bone grafts and supportive devices help maintain the spine’s natural shape.



The upper lumbar region – L-1 to L-4 – is particularly challenging, however. The most commonly used approach enters through the abdomen and extends through the abdominal cavity (peritoneum). In addition to the risk of small bowel obstruction and the formation of scar tissue in the peritoneum, major blood vessels and a network of sympathetic nerves must be separated or moved out of the way. Injury to these structures can cause complications ranging from blood loss to nerve damage. In men, this nerve damage can result in a condition called retrograde ejaculation in which semen escapes into the bladder instead of passing through the urethra.

Attempting to avoid these and other potential problems, some surgeons have accessed the lumbar spine through the patient’s side above the pelvis. Using this lateral approach, they advance the instruments behind the peritoneum rather than through it and they avoid major vessels and nerves, but they must retract the psoas muscle with considerable force. Tearing or bruising of this major muscle, which extends from the low back to the thigh, can cause significant pain, swelling and weakness after surgery.

Dr. Regan and his colleagues at Cedars-Sinai document for the first time in the Spine article a more direct lateral approach that actually goes through the psoas muscle, avoiding many of the risks of other approaches to the upper part of the lumbar spine. “Surgical dissection is carried out in a longitudinal fashion in line with the muscle fibers and through the anterior (forward) two-thirds of the psoas muscle. This results in minimal muscular retraction and bleeding with excellent visualization of the intervertebral disc space,” said Dr. Regan.

The procedure offers several practical advantages, as well. With the patient on his or her side, gravity draws the abdominal contents out of the way, for example, and the angle at which the spine is approached minimizes the risk of accidental injury to the spinal column during the fusion procedure.

The study is based on a review of 21 endoscopic lateral transpsoas procedures performed by Dr. Regan, senior author of the article. Six operations were completed at the Texas Back Institute in Dallas, where Dr. Regan was a principal before he joined Cedars-Sinai. All patients had previously undergone at least six months of non-surgical therapy and pain management.

Subjects ranged in age from 35 to 73 years, with a mean age of 50 years. Fourteen of those referred for surgery suffered from pain resulting from disc disease, three had disc instability at levels adjacent to discs that had previously been fused, and four suffered from progressive degenerative scoliosis.

Seventeen of the 21 patients underwent surgery for a single-level fusion (bone grafting of one disc space to fuse two vertebrae). One patient had a two-level fusion, and three patients underwent surgery on three levels. Because one operation had to be changed to a more open procedure because of scarring resulting from previous surgery, 20 patients are included in the analysis of results.

Six patients experienced post-operative numbness in the groin or thigh, and five of these patients also complained of pain in the area. For most of these patients, the symptoms resolved over a four-week period. Two patients who had persistent symptoms had undergone three-level fusion for scoliosis, and their symptoms continued to subside over time.

“Anatomic correction was achieved in all patients who underwent the lateral endoscopic approach, which provides direct and relatively easy access to the upper lumbar spine,” Dr. Regan said.

| Cedars-Sinai Medical Center
Further information:
http://www.csmc.edu

More articles from Health and Medicine:

nachricht Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University

nachricht The first analysis of Ewing's sarcoma methyloma opens doors to new treatments
01.12.2016 | IDIBELL-Bellvitge Biomedical Research Institute

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

Im Focus: Molecules change shape when wet

Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water

In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...

Im Focus: Fraunhofer ISE Develops Highly Compact, High Frequency DC/DC Converter for Aviation

The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.

Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

UTSA study describes new minimally invasive device to treat cancer and other illnesses

02.12.2016 | Medical Engineering

Plasma-zapping process could yield trans fat-free soybean oil product

02.12.2016 | Agricultural and Forestry Science

What do Netflix, Google and planetary systems have in common?

02.12.2016 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>