Webb Jonathan, Gottschalk Lionel, Lee Yu-Po, Garfin Steven, Kim Choll
Department of Orthopaedic Surgery, University of California, San Diego.
SAS J. 2008 Sep 1;2(3):145. doi: 10.1016/S1935-9810(08)70032-X.
Interest in minimally invasive surgery (MIS) of the spine has driven the development of new and innovative techniques to treat an ever wider range of spinal disorders. Despite these new advances, spine surgeons have been slow in adopting MIS into their clinical practice. This study aims to provide a better understanding of the factors that have led to limited incorporation of these procedures into their practices. METHODS: Eighty-seven spine surgeons completed a questionnaire related to their perceptions of MIS. Respondents were asked to comment on their perceptions regarding the limitations and advantages of minimally invasive spine surgery. Survey results were then analyzed for both overall opinions and opinions based on the amount of MIS utilization in the respondents' current practices. RESULTS: The top 3 identified limitations of MIS of the spine were technical difficulty, lack of convenient training opportunities, and radiation exposure. Of these respondents, spine surgeons experienced in MIS were concerned more with radiation exposure than the lack of training opportunities. In contrast, spine surgeons with little MIS experience cited the lack of training opportunities as the most significant limitation. There was little concern related to the limited proven clinical efficacy of MIS of the spine. DISCUSSION: Technical factors, training opportunities, and radiation exposure appear to be the major obstacles to MIS of the spine. Most spine surgeons believe that MIS leads to faster return to daily activities, better long-term function, and decreased hospitalization. This may explain why most surgeons did not cite a lack of proven efficacy as a major limitation to MIS. These findings indicate that the widespread adoption of MIS of the spine will likely be driven through relatively simple means, such as improved training programs that strive to decrease the technical difficulty and limit radiation exposure of these procedures. It is unlikely that extensive clinical data alone, without such improved training programs, will be sufficient to drive widespread use of minimally invasive spine surgery.
对脊柱微创手术（MIS）的关注推动了新技术的开发，以治疗范围越来越广的脊柱疾病。尽管有这些新进展，但脊柱外科医生在将MIS应用于临床实践方面进展缓慢。本研究旨在更好地理解导致这些手术在实践中应用受限的因素。
87名脊柱外科医生完成了一份关于他们对MIS看法的问卷。受访者被要求就他们对微创脊柱手术的局限性和优势的看法发表意见。然后分析调查结果的总体意见以及基于受访者当前实践中MIS使用量的意见。
脊柱MIS确定的前三大局限性是技术难度、缺乏便利的培训机会和辐射暴露。在这些受访者中，有MIS经验的脊柱外科医生更关注辐射暴露而非缺乏培训机会。相比之下，MIS经验较少的脊柱外科医生将缺乏培训机会视为最主要的局限性。对脊柱MIS有限的已证实临床疗效几乎没有担忧。
技术因素、培训机会和辐射暴露似乎是脊柱MIS的主要障碍。大多数脊柱外科医生认为MIS能使患者更快恢复日常活动、获得更好的长期功能并减少住院时间。这可能解释了为什么大多数外科医生没有将缺乏已证实的疗效作为MIS的主要局限性。这些发现表明，脊柱MIS的广泛应用可能会通过相对简单的方式来推动，比如改进培训项目，努力降低这些手术的技术难度并限制辐射暴露。如果没有这样改进的培训项目，仅靠广泛的临床数据不太可能足以推动微创脊柱手术的广泛应用。
