TY - JOUR
T1 - Awake minimally invasive transforaminal lumbar interbody fusion with a pedicle-based retraction system
AU - De Biase, Gaetano
AU - Bechtle, Perry
AU - Leone, Bruce
AU - Quinones-Hinojosa, Alfredo
AU - Abode-Iyamah, Kingsley
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2021/1
Y1 - 2021/1
N2 - Objective: Recently there has been increasing interest in the use of regional anesthesia for minimally-invasive transforaminal lumbar interbody fusion (TLIF) and laminectomy, with the goal of reducing the side effects and risks associated with general anesthesia and also to improve patient satisfaction. The goal of this technical note is to describe important perioperative aspects to safely perform an awake spine surgery and to describe a novel technique to preform minimally-invasive TLIF using a pedicle-based retraction system. Methods: We report our patient selection criteria, perioperative anesthesia protocol and surgical technique for awake TLIF with the Maximum Access Surgery (MAS) TLIF Retraction System. We describe an illustrative case of a 66-year-old female that presented with leg pain, lumbar MRI revealed a grade one spondylolisthesis at L4−5 with severe canal stenosis. She underwent a L4−5 Awake MIS TLIF using the MAS TLIF Retraction System. Results: The first 10 awake TLIF we performed with the MAS TLIF Retraction System had a mean procedure time of 117.3 min with a standard deviation (SD) of 13, and a mean total OR time of 151 min, SD 14.5. No surgery was converted under general anesthesia. No intraoperative complications were reported. Average length of stay was 1.3 ± 0.46 days. Conclusion: Awake MAS TLIF is a safe and effective technique, with the advantage of reducing the risk and side effect of general anesthesia and the approach-associated damage to soft tissues and morbidity. The pedicle-based distraction allows easier access to the intervertebral disc space for both disc preparation and cage placement.
AB - Objective: Recently there has been increasing interest in the use of regional anesthesia for minimally-invasive transforaminal lumbar interbody fusion (TLIF) and laminectomy, with the goal of reducing the side effects and risks associated with general anesthesia and also to improve patient satisfaction. The goal of this technical note is to describe important perioperative aspects to safely perform an awake spine surgery and to describe a novel technique to preform minimally-invasive TLIF using a pedicle-based retraction system. Methods: We report our patient selection criteria, perioperative anesthesia protocol and surgical technique for awake TLIF with the Maximum Access Surgery (MAS) TLIF Retraction System. We describe an illustrative case of a 66-year-old female that presented with leg pain, lumbar MRI revealed a grade one spondylolisthesis at L4−5 with severe canal stenosis. She underwent a L4−5 Awake MIS TLIF using the MAS TLIF Retraction System. Results: The first 10 awake TLIF we performed with the MAS TLIF Retraction System had a mean procedure time of 117.3 min with a standard deviation (SD) of 13, and a mean total OR time of 151 min, SD 14.5. No surgery was converted under general anesthesia. No intraoperative complications were reported. Average length of stay was 1.3 ± 0.46 days. Conclusion: Awake MAS TLIF is a safe and effective technique, with the advantage of reducing the risk and side effect of general anesthesia and the approach-associated damage to soft tissues and morbidity. The pedicle-based distraction allows easier access to the intervertebral disc space for both disc preparation and cage placement.
KW - Awake MIS TLIF
KW - Awake spine surgery
KW - MIS TLIF
KW - Spinal anesthesia
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U2 - 10.1016/j.clineuro.2020.106313
DO - 10.1016/j.clineuro.2020.106313
M3 - Article
C2 - 33139086
AN - SCOPUS:85094975118
SN - 0303-8467
VL - 200
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
M1 - 106313
ER -