Advancements in Minimally Invasive Surgery

Sep 1, 2024

MIS T-LIFT Lecture by Dr. Su

Introduction

  • Speaker: Dr. Su, Professor of Orthopedic Surgery
  • Institution: Northwestern University
  • Focus: Minimally Invasive Surgery (MIS)
  • Discussion on transitioning from open to MIS seamlessly

Key Points on MIS T-LIFT

Advantages of MIS

  • Faster recovery
  • Safer
  • Cost-effective
  • Self-sustaining technique
  • Techniques include MIS-TLIF, O-lift, laterals, etc.

Patient Considerations

  • Common patients: L4-5 Degenspondy, severe symptoms
  • Goals: Solid arthrodesis, optimized outcomes, patient satisfaction
  • Decision-making based on individual characteristics: age, disc height, facet joint condition, obesity, activity level

Procedures and Techniques

  • Non-operative to operative spectrum
  • Different procedures for specific pathologies
  • Factors influencing decision: sagittal balance, symptoms type, patient preferences

Interbody Fusion and Technology

Reasons for Interbody Fusion

  • Increased fusion rates with posterior interbody
  • Correction of deformity, stabilization, and lordosis are secondary benefits

Challenges in MIS

  • Poor access for surgeons compared to open TLIF
  • Need for potent biologics due to limited exposure

Technology and Efficiency

  • Navigation systems reduce OR time
  • Use of ORM, self-navigation, positioning techniques

MIS-TLIF Procedure Keys to Success

  • Avoid nerve root injury
  • Adequate disc exposure
  • Retractor placement critical
  • Knowledge of instrument lengths
  • Types of biologics and their handling

Cost and Efficiency

  • Reduced OR time and hospital stay
  • Reduced infection rates
  • Indirect cost savings through quicker recovery

Case Studies

Ideal Candidates

  • Elderly patients with L5 radiculopathy
  • Patients with residual foraminal stenosis after discectomy

Case Example

  • 45-year-old female, left lower extremity pain, failed conservative management
  • Procedure steps: Markings, retractor placement, disc exposure, and decompression

Discussion and Q&A

Topics Covered

  • Strategies to avoid radiculitis
  • Use of cortical screws
  • Decision-making for interbody placement in older patients
  • Achieving lordosis with various techniques

Additional Insights

  • Cost savings with MIS techniques compared to open procedures
  • Importance of surgical setup and efficiency
  • Personal experiences and adaptations in practice

Conclusion

  • MIS techniques, specifically MIS-TLIF, offer significant benefits for patients and healthcare systems
  • Continuous evolution and adaptation of techniques and technology can improve outcomes further.