Blake I Boadi, Chibuikem Anthony Ikwuegbuenyi, Sean Inzerillo, Gabrielle Dykhouse, Rachel Bratescu, Mazin Omer, Osama N Kashlan, Galal Elsayed, Roger Härtl
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引用次数: 0
Abstract
Objective: Minimally invasive spine surgery (MISS) employs small incisions and advanced techniques to minimize tissue damage while achieving similar outcomes to open surgery. MISS offers benefits such as reduced blood loss, shorter hospital stays, and lower costs. This review analyzes complications associated with MISS over the last 10 years, highlighting common issues and the impact of technological advancements.
Methods: A systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines was conducted using PubMed, MEDLINE, Embase via OVID, and Cochrane databases, covering publications from January 2013 to March 2024. Keywords related to MISS and complications were used. Studies on adult patients undergoing MISS with tubular, uniportal, or biportal endoscopy, reporting intraoperative or postoperative complications, were included. Non-English publications, abstracts, and small case series were excluded. Data on MISS approach, patient demographics, and complications were extracted and reviewed by 2 independent researchers.
Results: The search identified 880 studies, with 137 included after screening and exclusions. Key complications in cervical MISS were hematomas, transient nerve root palsy, and dural tears. In thoracic MISS, complications included cerebrospinal fluid leaks and durotomy. In lumbar MISS, common complications were incidental dural injuries, postoperative neuropathic conditions, and disc herniation recurrences. Complications varied by surgical approach.
Conclusion: MISS offers reduced anatomical disruption compared to open surgery, potentially decreasing nerve injury risk. However, complications such as nerve injuries, durotomies, and hardware misplacement still occur. Intraoperative neuromonitoring and advanced technologies like navigation can help mitigate these risks. Despite variability in complication rates, MISS remains a safe, effective alternative with ongoing advancements enhancing its outcomes.
目的：微创脊柱手术（MISS）采用小切口和先进技术，最大限度地减少组织损伤，同时达到与开放手术相似的效果。微创手术具有减少失血、缩短住院时间和降低成本等优点。本综述分析了过去 10 年中与 MISS 相关的并发症，强调了常见问题和技术进步的影响：按照 PRISMA（系统综述和元分析首选报告项目）指南，使用 PubMed、MEDLINE、Embase via OVID 和 Cochrane 数据库进行了系统综述，涵盖了 2013 年 1 月至 2024 年 3 月期间的出版物。研究使用了与 MISS 和并发症相关的关键词。研究对象包括接受管式、单孔或双孔内窥镜 MISS 的成年患者，并报告了术中或术后并发症。非英语出版物、摘要和小型病例系列被排除在外。有关 MISS 方法、患者人口统计学和并发症的数据由两名独立研究人员提取和审查：结果：搜索共发现了 880 项研究，经筛选和排除后纳入了 137 项。颈部 MISS 的主要并发症是血肿、一过性神经根麻痹和硬膜撕裂。胸部 MISS 的并发症包括脑脊液漏和硬脑膜撕裂。在腰椎MISS手术中，常见的并发症是硬膜意外损伤、术后神经病理性症状和椎间盘突出症复发。并发症因手术方式而异：结论：与开腹手术相比，MISS 可减少解剖结构的破坏，从而降低神经损伤的风险。结论：与开腹手术相比，MISS 减少了对解剖结构的破坏，潜在地降低了神经损伤的风险，但神经损伤、颅骨切开和硬件错位等并发症仍时有发生。术中神经监测和导航等先进技术有助于降低这些风险。尽管并发症发生率存在差异，但 MISS 仍然是一种安全、有效的替代方法，而且其成果也在不断进步。
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