tecnicas de cirugia minima invasion

1. MINIMA INVASION
CIRUGIA DE COLUMNA

2. PERSPECTIVA HISTORICA …
1. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review.
Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
2. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
CIRUGIA
CONVENCIONAL
(TECNICAS TRADICIONALES)

3. PERSPECTIVA HISTORICA …
EVOLUCION
CIRUGIA MINIMAMENTE INVASIVA
1. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review.
Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
2. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.

4. PERSPECTIVA HISTORICA …
ACTUALIDAD
CIRUGIA MINIMAMENTE INVASIVA
1. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review.
Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
2. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.

5. MISS …
ABORDAJE QUIRURGICO
1. Oppenheimer, J.
Decastro, I.
Mcdonnel, M.
Minimally Invasive
Spine Technology
and Minimally
Invasive Spine
Surgery: A Historical
Review.
Neurosurgery
Focus; Volume 27;
Pag 1-15:
September 2009.
2. Benzel, O et al.
Minimally Invasive
Spine Surgery,
Springer Media,
2009.
LESION
CORREDOR QUIRURGICO

6. MISS …
ABORDAJE
QUIRURGICO
1. Oppenheimer, J.
Decastro, I.
Mcdonnel, M.
Minimally Invasive
Spine Technology
and Minimally
Invasive Spine
Surgery: A Historical
Review.
Neurosurgery
Focus; Volume 27;
Pag 1-15:
September 2009.
2. Benzel, O et al.
Minimally Invasive
Spine Surgery,
Springer Media,
2009.
LESION
CORREDOR
QUIRURGICO

7. MISS … ABORDAJE
QUIRURGICO
1. Oppenheimer, J.
Decastro, I.
Mcdonnel, M.
Minimally Invasive
Spine Technology
and Minimally
Invasive Spine
Surgery: A Historical
Review.
Neurosurgery
Focus; Volume 27;
Pag 1-15:
September 2009.
2. Benzel, O et al.
Minimally Invasive
Spine Surgery,
Springer Media,
2009.
CORREDOR
QUIRURGICO
LESION

8. FUNDAMENTO FISIOLOGICO …
1. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure
versus conventional open approach. European Spine Journal 2010; 19:316–324.
2. Datta, G. et al. Back pain and disability after lumbar laminectomy: Is there a relation to muscle retraction. Neursurgery 2004: 20-35.

9. 1. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure
versus conventional open approach. European Spine Journal 2010; 19:316–324.
2. Datta, G. et al. Back pain and disability after lumbar laminectomy: Is there a relation to muscle retraction. Neursurgery 2004: 20-35.

10. FUNDAMENTO FISIOLOGICO…
1.- Necrosis e inflamación evidentes 1 semana.
2.- Cambio fibrótico 3 y 6 semanas.
3.- Degeneración grasa 12 y 24 semanas.

11. FUNDAMENTO FISIOLOGICO …
• 3 Grupos:
Grupo A: 2 horas continuas.
Grupo B: 1 hora y 5 minutos descanso.
Grupo C: 40 minutos y 5 minutos descanso.
• Examen inmunohistoquímico, electrofisiologico y microcscopico en 48 horas, 1
semana, 6 semanas.
• CPK >Grupo A > Grado de Regeneracion y Daño tisular.

12. FUNDAMENTO FISIOLOGICO …
• 20 pacientes; Presión intramuscular
Medición a 5, 30, 60 min en la cirugía
• Biopsia muscular antes y después de la retracción utilizando ATP con birrefringencia.
• Resultados:
Aumento significativo de AMPC durante la retracción
Retracción < disminución del ATP

13. PATOLOGIAS …
1. Datta, G. et al. Back pain and disability after lumbar laminectomy: Is
there a relation to muscle retraction. Neursurgery 2004: pp 20-35.

14. BENEFICIOS …
Incision
Retraccion
Muscular
Cicatriz
Sangrado
Estancia
Dolor
1. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure
versus conventional open approach. European Spine Journal 2010; 19:316–324.
2. Datta, G. et al. Back pain and disability after lumbar laminectomy: Is there a relation to muscle retraction. Neursurgery 2004: 20-35.

15. MISS… Microscopía
Percutaneo
Endoscopía
Laparoscopía
Accesos Tubulares
Procedimientos
Hibridos
1. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review.
Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
2. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.

16. MISS…
1. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review.
Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
2. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
Microscopía
INCISIONES PEQUEÑAS:
1.- Microdisectomia

17. MISS…
1. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review.
Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
2. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
SIN INCISION:
1.- Quemonucleolisis
2.- Nucleotomia
3.- Vertebroplastia
4.- Xifoplastia
5.- Bloqueo
6.- Ablacion
Percutaneo

18. MISS…
1. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review.
Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
2. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
PUERTA Y LLAVE:
1.- Discectomia Toracica
2.- Discectomia Lumbar
3.- Deformidad Toracica
4.- Manejo de Trauma
Endoscopía

19. MISS…
1. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review.
Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
2. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
ESPACIO VIRTUAL:
1.- Discectomia Toracica
2.- Discectomia Lumbar
3.- Deformidad Toracica
Laparoscopía

20. MISS…
1. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review.
Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
2. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
MINIMA RETRACCION Y DISECCION MUSCULAR:
1. METRx
2. MIRA
3. AccuVision Minimally Invasive spine System
4. NAPA Minimally Invasive Retractor System
5. Serengeti Retractor System
6. Luxor Minimally Invasive Retractor System
Accesos Tubulares

21. MISS…
1. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review.
Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
2. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
RECOMBINADOS Y NUEVAS TECNOLOGIAS:
1. Discectomia Percutanea Asistida con Laser.
2. X-STOP
3. AxiaLIF
Procedimientos
Hibridos

22. ENFOQUE MISS …
FUSION DESCOMPRESION
RECONSTRUCCIO
N
RESECCION
1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.

23. ENFOQUE MISS …
1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
FUSION
Fusión intersomática
Postero Lateral
(DLIF).
Fusion Extremo
Lateral (XLIF).
Fusión Posterior
Lumbar (PLIF).
Fusión
Transforaminal
(TLIF).
Fusion Anterior
Lumbar (ALIF).
Fusion Axial
(AxiaLIF).
Fusion Extraforaminal
(ETLIF).

24. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
PLIF
FUSION
• 1936 Mercer “Fusión Intersomática”
• 1940 PLIF Autoinjerto apófisis espinosa
• 1951 Cloward “331 Pacientes” 85% satisfacción; amplia variabilidad en sus
resultados clínicos y las tasas de fusión
• Modificaciones de la técnica intercorporal: Cresta Ilíaca, Injertos Autólogos,
Aloinjerto Oseo, Implantes Metalicos, Fibra de Carbono
• Alta tasa de Pseudoartrosis; Uso además, de Tormillos transpediculares.
GENERALIDADES…

25. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
PLIF
FUSION
Ventajas:
1.- Amplia zona de contacto de injerto óseo intervertebral
2.- Mejor suministro de sangre al injerto centro vertebral
3.- Centro de fusión próximo al centro de movimiento
4.- Mejora el intercambio de carga entre el injerto y el hueso
5.- Descompresión completa del agujero intervertebral y
raíz nerviosa
6.- Restauración de distancia entre cuerpos y la altura neural foraminal
7.- Mantener la lordosis segmentaria en el segmento fusionado
VENTAJAS…

26. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
PLIF
FUSION
1.- Espondilolistesis
2.- Hernia discal de novo o recurrente
3.- Cirugía lumbar fallida
4.- Inestabilidad segmentaria
5.- Enfermedad degenerativa del disco
INDICACIONES…

27. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
PLIF
FUSION
• Gill y Blumentahal: 238 pacientes
Fusión sólida en el 92 %
Sin dolor 61%
Ligero Dolor 26 %
2 años: 13% dolor residual
• Steffee y Brantigan: 169 pacientes
86 % Espondilolistesis / TF 91.5 %
80 % Cirugia Lumbar Fallida / TF 92 %
78 % Estenosis Espinal / TF 97 %
• Lanzino: revisión de 2816 casos
Excelente resultado en 85 %
Tasa de Fusión 89%
Tasa de fracaso 13 %
RESULTADOS…

28. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
TLIF
1) Descompresión Neural via Transforaminal
2) Eliminación de la articulación facetaria
3) Fusión intersomática
4) Tornillos via pedicular
FUSION
OBJETIVOS…

29. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
TLIF
• Menor tasa complicaciones <4%
• Eliminación de cicatrices durales
• Menor sangrado intraoperatorio
• Enfoque unilateral, complejo musculoligamentous
FUSION
VENTAJAS…

30. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
TLIF
• Liberación de corredor quirúrgico
• Descompresión directa
• Estabilización
• Fusión
FUSION
INDICACIONES…

31. 1. Video Atlas of Operative Neurosurgery, Minimally Invasive Spine Surgery, Suplement to Neurosurgical Focus; July 2013, Volume 36, Issue 1.
2. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
3. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
4. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013
TLIF

32. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
TLIF
FUSION
RESULTADOS…

33. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
TLIF
FUSION
RESULTADOS…

34. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
ALIF
• Inestabilidad degenerativa
• Espondilolistesis degenerativa
• Espondilolistesis itsmica
• Canal lumbar estrecho con inestabilidad.
• Dolor poslaminectomía persistente.
• Pseudoartrosis luego de otros tipos de fusión.
FUSION
INDICACIONES…

35. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
ALIF
1.- VIAABIERTA
Transperitoneal microsurgical approach
(L5-S1)
2.- VIA LAPAROSCOPICA
Retroperitoneal microsurgical approach
(L2-L3,L3-L4,L4-L5)
FUSION
VARIANTES…

36. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
ALIF

37. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
ALIF
FUSION

38. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
ALIF
ABIERTO LAPAROSCOPICO
VIA
240 ANTERIOR 131 MIN
305 POSTERIOR 103 MIN
SANGRADO 288 ML
ESTANCIA 4.1 DIAS
VIA
175 ANTERIOR 201 MIN
256 POSTERIOR 134 MIN
SANGRADO 141.7 ML
ESTANCIA 3.3 DIAS
Anderson. G. Eur Spine J. 25 March 2011.
FUSION
RESULTADOS…

39. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
XLIF
• Abordaje retroperitoneal
Incisión flanco
Microscopio
Endoscopio
1.- Enfermedad degenerativa del disco
2.- Hernia discal recurrente
3.- Espondilolistesis
4.- Pseudoartrosis
5.- Osteomielitis
6.- Discitis
7.- Sindrome postlaminectomía
8.- Tumores anteriores y laterales toracolumbares
9.- Deformidad de la columna debilitante (escoliosis).
FUSION
INDICACIONES…

40. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
XLIF

41. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
AxialLIF
Desarrollado por Cragg, 2004
• Preservación de tejidos blandos
• Restauración de la altura del disco
• Fijación segmentaria rígida inmediata y estabilidad
de L4-S1
• Corredor Virgen por un segmento previamente operado
• Permite la fusión de L5-S1 afeccion de elementos de la columna
Complicaciones
• Hemorragia
• Perforación del intestino
• Infección
FUSION
GENERALIDADES…

42. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
AxialLIF
FUSION

43. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
ETLIF
Diaz y Berbeo; Fusion Intercorporal Lumbar Extraforaminal
1.- Multifidos y Longisimo (TLIF)
2.- Abordaje mas lateral Longisimo e Iliolumbar
3.- Denervacion Faetaria
4.- Facetectomia Parcial
5.- Disectomia
FUSION
GENERALIDADES…

44. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
ETLIF
VARIABLE MAYOR MENOR
SEXO M: 25 F: 44
EDAD > 85 A < 45 A
SINTOMA AXIAL-RADICULAR (45%) RADICULAR (24%)
NIVEL L4-L5 (90%) L5-S1 (5%)
TIEMPO QUIRURGICO 193.25 MIN 95 MIN
SANGRADO 462 ML 250 ML
ABORDAJE IZQUIERDO (62%) DERECHO (38%)
FUSION

45. ENFOQUE MISS …
1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
DESCOMPRESION
Disectomia
Endoscopica
Disectomia
Microscopica
Laminectoma
Foraminotomia
Disectomia Endoscopica
Toracica Videoasistida
Disectomia Percutanea
Laser Asistida
Disectomia
Percutanea

46. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
DESCOMPRESION
Disectomia
Microscopica
1.- Ventana Interlaminar
• Microscopio
2.- Indicaciones:
Hernia discal
Hernia bisegmentaria Adyacente
Atrapamiento de la razi
Estenosis de canal lateral
3.- Contraindicaciones:
Estenosis del canal espinal
> 2 discos nivel
Espacio interlaminar
GENERALIDADES…

47. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
DESCOMPRESION
1.- 1997
Dilatador y retractor tubular
Endoscopio discectomía
2.-Ventajas
Reduce el trauma del tejido
Visualización Integral
Visualización directa de la raíz nerviosa
Permite la descompresión ósea
3.- Desventajas
Curva de aprendizaje
Ruptura Dural difícil de reparar
Disectomia
Endoscopica GENERALIDADES…

48. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
Disectomia
Endoscopica

49. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
Laminectomia
Endoscopica
1.- Menor trauma a los tejidos blandos
2.- disminuye lesión muscular
3.- Mejora la visualización de las laminas
4.- Mejora el grado de descompresión laminar hasta 45%
GENERALIDADES…

50. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
Laminectomia
Endoscopica RESULTADOS…

51. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
Foraminotomia
RESULTADOS…

52. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
DESCOMPRESION
Foraminotomia
RESULTADOS…

53. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
DESCOMPRESION
Disectomia Percutanea
Laser Asistida
1.- Fue descrita por primera vez en 1984
Colocacion percutánea en disco
Fibra óptica se introduce energía laser al interior del disco
2.- La energía laser:
Pequeñas cargas de energía
Se realizan pulsaciones rítmicas
Aspiración e irrigación
3.- Mejoría de la sintomatología hasta en 70 a 80 %.
4.- Complicaciones:
Discitís
Perforación aortica de V cava y vasos iliacos
Perforación de órganos abdominales
Síndrome de la cauda equina.
GENERALIDADES…

54. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
Disectomia Percutanea
1.- Fue diseñada en 1975: Nucleotomia parcial mediante un abordaje postero-lateral.
2.- En 1983 Kambin y Gellman diseñan el abordaje dorso-lateral.
3.- Indicaciones
Pacientes con enfermedad en un solo nivel
Disco rotos con fragmentos contenidos
Espacios intervertebrales amplios
Protrusión discal leves
GENERALIDADES…

55. ENFOQUE MISS …
1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
RECONSTRUCCION
Xifoplastia.
Vertebroplastia.
Laminoplastia.

56. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
1.- Deramond et al (1987)
2.- Indicaciones:
Dolor causado por la osteoporosis
Fracturas por compresión
Dolor por MAVS
Dolor por tumores a invasión al canal
3.- Contraindicaciones:
Infección sistémica o medular
Diátesis hemorrágica no corregida
Deficit cardiopulmonar
Fractura relacionada con compromiso del canal
RECONSTRUCCION
Vertebroplastia GENERALIDADES…

57. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
4.- Complicaciones: Incidencia: <10%
Aumento del dolor
Radiculopatía
Compresión del cordón
Infección
Fractura de costilla
Embolismo venoso
Migracion > radiculopatía, 4%; compresión 0,5%)
RECONSTRUCCION
Vertebroplastia GENERALIDADES…

58. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
RECONSTRUCCION
Vertebroplastia

59. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
RECONSTRUCCION
Xifoplastia
1.- Es una variante de la vertebropalstia.
Se infla un balón en el espesor de la vertebra colapsada
Restaura la altura y evita la xifosis posterior
Seguida de inyección de polimetilmetacrilato
2.- Riesgos
Tiene el riesgo de la extravasación del cemento
Compresión por efecto de masa
Radiculopatia
Alteraciones en los segmentos adyacentes.
GENERALIDADES…

60. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
Xifoplastia

61. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
RESECCION
ENFOQUE MISS …

62. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
RESECCION
Reseccion
Intra y Extradural
• Incision bilateral
• Retraccion muscular
• Laminectomía multinivel
• Dolor
• Menor pérdida de sangre
• Alta velocidad de recuperación
• Integridad estructural de la columna vertebral
GENERALIDADES…

63. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
Reseccion
Intra y Extradural

64. Reseccion
Intra y Extradural

65. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
RESECCION
Reseccion
Intra y Extradural

66. 1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14, November 2002.
2. Oppenheimer, J. Decastro, I. Mcdonnel, M. Minimally Invasive Spine Technology and Minimally Invasive Spine Surgery: A Historical Review. Neurosurgery Focus; Volume 27; Pag 1-15: September 2009.
3. Benzel, O et al. Minimally Invasive Spine Surgery, Springer Media, 2009.
4. ShunWu, F. ZhiJun, H. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. European Spine Journal; 19:316–324, 2010.
5. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective Cohort Study. Neurosurgery 72:151–159, 2013.
RESECCION
Reseccion
Intra y Extradural

67. FUTURO… HIBRIDOS
1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14
2. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective
Cohort Study. Neurosurgery 72:151–159, 2013

68. FUTURO… HIBRIDOS
1. Jaikumar, S. et al. History of Minimally Invasive Spine Surgery. Neurosurgery 51; Supplement 2:1-14
2. Park, P. La Marca, F. Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis: A Retrospective
Cohort Study. Neurosurgery 72:151–159, 2013