Minimally Invasive Spine Surgery (MISS) in China

摘要

Minimally Invasive Spine Surgery (MISS) has been defined by McAfee et al. (McAfee PC, 2010) as: “a procedure that by virtue of the extent and means of surgical techniques results in less collateral tissue damage, resulting in measurable decrease in morbidity and more rapid functional recovery than traditional exposures, without differentiation in the intended surgical goal”. Increasingly, minimally invasive surgeries are desirable by both patients and surgeons. In the past few years various minimally invasive spinal surgeries have been developed for, and introduced into, the clinical setting. Procedures may involve one or more of the four “pillars” of MISS (Hartl, 2012), including microsurgical techniques, access strategies to the spine, imaging/navigation techniques, and specialized instruments and implants. The concepts and techniques of MISS have spread throughout China rapidly as a result of direct communication with surgeons worldwide. The first academic society on MISS was established in China in Oct. 2003. Four hundred surgeons participated in the first national meeting on MISS held in Dec. 2004 (YL Chi, 2005). Since then, increased numbers of orthopaedic and neurosurgeons have become interested in MISS. Training courses on special techniques, such as percutaneous vertebroplasty/kyphoplasty, percutaneous pedicle screw instrumentation, and percutaneous endoscopic lumbar discectomy, were held regularly in training centers, promoting the development of MISS in China. With nearly two decades of development, Chinese surgeons have developed MISS instruments and techniques while collecting an extensive amount of clinical data. This special issue includes eight original peer reviewed papers in this field authored by Chinese surgeons. Compared to MISS based on intra-operative radiographs, computer-assisted MISS (CAMISS), in which navigation plays an important role, is a great advance towards more precise and safer surgery. Prof. Wei Tian's team has developed an universal navigation-based robot system which potentially can be used in guiding instrumentation of every part of the body. His team reported the first case of robot-assisted posterior C1-2 transarticular screw fixation for atlantoaxial instability. The details of this new technique was described in this report. Navigation may improve the safety and efficacy of instrumentation by guiding the trajectory of screws in real time but it still cannot overcome the shortcomings of surgeon's skill, requiring repeated adjustments of the trajectories during surgery. Instrumentation of upper cervical spine, especially in deformed spine is still challenging due to the complex anatomy and proximity to important neurovascular structures even with navigation. Navigation-based robot may solve this problem. Several minimally invasive techniques maybe integrated in one operation to achieve better results. Prof. Jian Wang reported his experience of using intraoperative O-arm-based navigation and microendoscopic techniques in direct repair of lumbar pars interarticularis. Dr. Yutong Gu combined percutaneous pedicle screw fixation and vertebroplasty for treatment of thoracic metastatic tumors with neurologic compression. Dr. Changqing Li performed a prospective randomized study on minimally invasive posterior decompression combined with percutaneous pedicle screw fixation for the treatment of thoracolumbar fractures with neurological deficits compared with traditional open posterior surgery. Percutaneous Endoscopic Lumbar Discectomy is becoming increasingly popular in China. Dr. Jiancheng Zeng reported the results of a prospective randomized controlled study comparing interlaminar approach and transforaminal approach for L5-S1 disc herniation. China has a large aging population. Chinese orthopaedic surgeons are facing an increasingly large number of patients with osteoporotic vertebral compression fractures. Prof. Huilin Yang reviewed the history and present use of kyphoplasty and its developm