Page 108 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Masterclasses

M5.3 Minimally Invasive Spine Surgery 14:30 Room 221

Minimally Invasive Spine Surgery: Limitation
Li KK
Orthopaedics and Traumatology Department, Queen Elizabeth Hospital, Hong Kong

Minimally invasive spine surgery (MISS) has been shown to decrease the soft tissue traumatization and hence facilitate the
subsequent rehabilitation. It has been gaining increasing popularity in recent years and applied in various aspects in spinal
surgery including, degeneration, trauma, infection and metastasis. However, one should also, at the same time, need to
understand the present limitations before fully embracing the technology. Anatomical consideration of the spinal column and
the targeted pathology are definitely one of the concerns. Moreover, complex spinal deformity correction, revision surgery
and vertebral tumour resection may pose another limitation to the application MISS. Radiation exposure and concomitant
usage of other supportive equipment during MISS are also the other major issues to be addressed. Last but not least,
the steep learning curve is one of the major hurdles to overcome before fully embarking on the technique. Literature has
demonstrated that longer operative time and relatively higher surgical complication rate at the initial phase of skill acquisition
are the serious consideration. Moreover, there are certain generic surgical complications associated with MISS. Hence, not
only the availability of the adequate equipment but also the presence of the experienced personnel is the key to success
in practicing MISS. Moreover, the surgical team should, at the same time, equipped themselves with the technique of the
traditional open surgery just in case when the minimally invasive approach is not practicable. In summary, MISS has the
advantage of less tissue traumatization but comprehensive training with respect to the knowledge and surgical skill is
imperative.

Tuesday, 3 May

M5.4 Minimally Invasive Spine Surgery 14:30 Room 221

Minimally Invasive Spine Surgery: Training
Kwan K
Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong

The essence of Minimally Invasive Spine Surgery (MISS) involves a smaller access to the spine and the neural elements, but
the principles and the technical aspects of the surgery are the same as open surgery. Hence the indications and goals of
surgery should not be compromised. MISS should merely be an alternative access method to accomplish the same surgical
outcome.

Spine surgeons trained in open surgery have a thorough understanding of the three dimensional anatomy of the spine, which
helps to reconstruct the mental image when the access and view are reduced. Nonetheless, spine surgeons need to undergo
specific training for each type of access and assess what needs to be achieved. This involves self study, overseas training
with experienced operators, cadaveric training, with auditing of our own results. In some specific circumstances, overseas
trainer maybe invited to supervise and assist the initial procedure. The learning curve of each technique must be understood,
and more simple cases are selected at the beginning.

Currently the application of MISS includes pedicle screw insertion, decompression of the neural elements, lateral access
interbody fusion, and various injection techniques.

106