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• W3204162880 abstract "“Incredibly, laparoscopy has been almost neglected by surgeons, except for pelviscopy, a highly perfected technique used effectively by gynaecologists. This procedure has in fact revolutionised the science of gynaecology. The degree to which we as surgeons ignored the sophisticated technology and refused to test its suitability for surgical application is astonishing.” Thus spoke Hand Troidl in his presidential address at the International Congress on Surgical Endoscopy in Berlin 1988.1Kelley Jr., W.E. The evolution of laparoscopy and the revolution in surgery in the decade of the 1990s.J Soc Laparoendosc Surg : J Soc Laparoendosc Surg. 2008; 12: 351-357PubMed Google Scholar Laparoscopy was kept alive mainly by the gynaecologists from 1930's to 1980's. The general surgical community then adapted this technique, and now this has become the standard way of performing most abdominal surgery. When I was a medical student (1990–95), I was amazed that laparoscopic technique could be used to take out something dangerous like renal cell cancer from a relative of mine, the surgery being performed at AIIMS, New Delhi. There is hardly any elective surgery that is not done using laparoscopy these days. This success of minimally invasive surgery (MIS) in the abdomen has played a major part in giving general acceptance to the use of similar techniques in other surgical specialities as well. The human spine is a complex structure with complex biomechanics. The human intervertebral disc at each functional spinal unit (FSU) has evolved over centuries to be well suited to its mechanical function. But we as human beings are living longer than in the medieval times. There has been a rapid advance in medical imaging technologies in the last 50 years, and this has enabled increased human understanding of medicine. With widespread access to health technologies in many populations across different continents, the role played by degeneration of the intervertebral disc in normal ageing versus pathology has come into increasing focus. We all want to be as mobile as we can for as long as possible as we grow older. Spinal surgical treatment has evolved to try and keep pace with these demands. With the invention of poly axial pedicle screws along with other technical advances in spinal instruments/cages/disc replacements, the number of surgeries being performed in human spine has been increasing with every decade after 1990. Only when the natural history of the spinal condition is not in the patient's favour, and non-operative conservative measures have been exhausted, surgical treatments are usually proposed by surgeons. These are usually performed to free the pressure on the spinal cord and/or nerves (decompression), abolish motion (fusion techniques) for pain relief, preserve/modify motion in a functional spinal unit and to correct spinal alignment in cases with deformity. Many of these goals of spinal surgery can be achieved using Minimally Invasive Spine Surgery these days. Kim et al.2Kim M. Kim H.S. Oh S.W. et al.Evolution of spinal endoscopic surgery.Neurospine. 2019 Mar; 16 (PMID: 31618807; PMCID: PMC6449828): 6-14Crossref PubMed Scopus (45) Google Scholar wrote a nice review article on the evolution of spinal endoscopic surgery. The 1st generation of spinal endoscopy started with early attempts by Kambin (1973) and Hijikata (1975), mostly dry endoscopy without great direct visualisation. However, this early first-generation technique only advanced after Arthur Yeung (1998) used irrigation along with these trans-foraminal endoscopy techniques to help increase the visualisation during these procedures. The 2nd generation of endoscopic spine surgery started with the development of Fully Endoscopic inter-laminar techniques, S. Ruetten being the main exponent of these techniques. Ruetten et al. not only became proficient in this technique, but they also published good quality evidence in the form of randomised studies to prove the benefits of Fully endoscopic Inter-laminar techniques in the lumbar and cervical spine.3Ruetten S. Komp M. Merk H. Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study.Spine. 2008 Apr 20; 33 (PMID: 18427312): 931-939https://doi.org/10.1097/BRS.0b013e31816c8af7Crossref PubMed Scopus (478) Google Scholar, 4Ruetten S. Komp M. Merk H. Godolias G. Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision.J Spinal Disord Tech. 2009 Apr; 22 (PMID: 19342934): 122-129https://doi.org/10.1097/BSD.0b013e318175ddb4Crossref PubMed Scopus (167) Google Scholar, 5Ruetten S. Komp M. Merk H. Godolias G. Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study.Spine. 2008 Apr 20; 33 (PMID: 18427313): 940-948https://doi.org/10.1097/BRS.0b013e31816c8b67Crossref PubMed Scopus (210) Google Scholar, 6Ruetten S. Komp M. Merk H. Godolias G. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study.J Neurosurg Spine. 2009 May; 10: 476-485Crossref PubMed Scopus (166) Google Scholar The 3rd generation of endoscopic spine surgery started with use of endoscopic techniques to perform a lumbar decompression-a unilateral approach for bilateral endoscopic decompression (known as interlaminar endoscopy – unilateral laminotomy with bilateral decompression, IE-ULBD). There are already skilled surgeons introducing newer innovations of these endoscopic surgical techniques in the cervical, thoracic and lumbar spine including fusion surgery, with increasing reports in the literature in the last few years. It was only a matter of time before the poly axial pedicle screws placed via open techniques was transformed into percutaneous techniques. The ability to place these pedicle screws using MIS techniques raised the possibility of performing other spine surgeries minimally invasively as well. As traditional open spine surgery became increasingly common from 1990-early 2000's, the surgeons desire to come up with new and innovative ways to perform these procedures was coupled perfectly with advances in medical equipment and engineering, resulting in the birth of minimally invasive surgeries in Spine. At the end of the day what matters is patient experience and comfort. This reduction of post-operative morbidity and getting back to normal life as soon as possible has been the primary driving force behind the phenomenal rise in the use of MIS surgery in spine. Only those techniques that give equivalent medium- and long-term results have stood the test of time, and many a technique has been proposed with great fanfare only to fade away after a few years as results don't back it up. Main exponents of surgical advances have been able to produce good quality evidence to back these techniques up. Take the use of spinal endoscopy as an example, up until the year 2016, there used to be 40 to 50 publications every year on this topic. In the year 2020, there were just over 250 articles on spinal endoscopy, a 5-times increase. Likewise, the advent of techniques like lateral trans-psoas lumbar inter-body fusion, MIS TLIF techniques and percutaneous pedicle screw placements along with navigation and robotics have allowed the use of these minimally invasive techniques in difficult and challenging cases. Surgery for Adult degenerative scoliosis has also increased manifold over the last two decades. People with this condition are usually quite elderly, have significant restrictions on their quality of life and are looking for solutions to keep mobile for as long as possible. The full benefit of MIS techniques would be best evident in people with this condition and age group. This special issue contains articles on use of MIS-TLIF and Lateral Lumbar Interbody Fusion, which should be useful for its readers.7Phani Kiran S. Sudhir G. Minimally invasive transforaminal lumbar interbody fusion — a narrative review on the present status.Journal of Clinical Orthopaedics and Trauma. 2021; 22 (101592, ISSN 0976-5662)https://doi.org/10.1016/j.jcot.2021.101592Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,8Batheja D. Dhamija B. Ghodke A. Anand S.S. Balain B.S. Lateral lumbar interbody fusion in adult spine deformity – a review of literature.Journal of Clinical Orthopaedics and Trauma. 2021; https://doi.org/10.1016/j.jcot.2021.101597Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Another group of patients where MIS surgery has been very helpful is in the field of metastatic spinal cord compression (MSCC), as minimising morbidity and improving quality of life in these patients despite a limited lifespan has become even more important.9Dhamija B. Batheja D. Balain B. A systematic review of MIS and Open Decompression surgery for spinal metastases in the last two decades.Journal of Clinical Orthopaedics and Trauma. 2021; ((- accepted for publication)Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Keeping pace with these surgical techniques has been important for the anaesthetists as well. Garg et al. recently published an interesting review on Awake Spinal Fusion.10Garg B. Ahuja K. Mehta N. Sharan A.D. Awake spinal fusion.JBJS Rev. 2021 Jun 14; 9 (PMID: 34125737)https://doi.org/10.2106/JBJS.RVW.20.00163Crossref PubMed Scopus (1) Google Scholar They conclude that although current evidence is limited, recent advances in anaesthetic techniques do benefit spinal surgery patients in the immediate and early post-operative period. Conscious sedation has been commonly used in endoscopy techniques, mainly trans-foraminal, and more recently long-acting bupivacaine along with conscious sedation has been used to perform endoscopic TLIF procedures with MIS Screw fixation.11Kolcun J.P.G. Brusko G.D. Basil G.W. Epstein R. Wang M.Y. Endoscopic transforaminal lumbar interbody fusion without general anesthesia: operative and clinical outcomes in 100 consecutive patients with a minimum 1-year follow-up.Neurosurg Focus. 2019 Apr 1; 46: E14https://doi.org/10.3171/2018.12Crossref PubMed Google Scholar This special issue contains three articles on use of spinal anaesthesia to perform lumbar fusion surgeries by different groups, proving that it is indeed possible to use regional/awake anaesthesia to perform lumbar spine fusion surgery-whether it is open surgery done by adept surgeons or by using MIS techniques or utilising endoscopic techniques.12Ahmed Jonayed S. Alam M.S. Al Mamun Choudhury A. Akter S. Chakraborty S. Efficacy, safety, and reliability of surgery on the lumbar spine under general versus spinal anesthesia- an analysis of 64 cases.J Clin Orthop Trauma. 2021 Jan 8; 16 (PMID: 33717954; PMCID: PMC7920005): 176-181https://doi.org/10.1016/j.jcot.2020.12.032Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 13Sarkar S. Banerji A. Chattopadhyaya A. Banerjee S. Lumbar spine instrumented fusion surgery under spinal anaesthesia versus general anaesthesia-A retrospective study of 239 cases.J Clin Orthop Trauma. 2021 May 2; 18 (PMID: 34026488; PMCID: PMC8122088): 205-208https://doi.org/10.1016/j.jcot.2021.04.026Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 14Sekerak R. Mostafa E. Morris M.T. Nessim A. Vira A. Sharan A. Comparative outcome analysis of spinal anesthesia versus general anesthesia in lumbar fusion surgery.J Clin Orthop Trauma. 2020 Nov 27; 13 (PMID: 33680810; PMCID: PMC7919949): 122-126https://doi.org/10.1016/j.jcot.2020.11.017Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar The advances in surgical technology, cell biologics/artificial bone grafts, anaesthetic techniques and surgical skills are now matching pace with the increasing patient demand for MIS surgery. Whether we like it or not, patient demand will drive the use of MIS Spine surgery upwards. Whether we are trained to do MIS surgery or not, the young generation of spinal surgeons has embraced it, and the older open traditional techniques are only used as a backup or in extremely complex cases, akin to the rise of laparoscopic surgery in the abdomen." @default.
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