Spetzger Uwe, Von Schilling Andrej, Winkler Gerd, Wahrburg Jürgen, König Alexander
Department of Neurosurgery, Klinikum Karlsruhe, Karlsruhe, Germany.
Minim Invasive Ther Allied Technol. 2013 Aug;22(4):227-41. doi: 10.3109/13645706.2013.821414.
In the last 25 years of spinal surgery, tremendous improvements have been made. The development of smart technologies with the overall aim of reducing surgical trauma has resulted in the concept of minimally invasive surgical techniques. Enhancements in microsurgery, endoscopy and various percutaneous techniques, as well as improvement of implant materials, have proven to be milestones. The advancement of training of spine surgeons and the integration of image guidance with precise intraoperative imaging, computer- and robot-assisted treatment modalities constitute the era of reducing treatment morbidity in spinal surgery. This progress has led to the present era of preserving spinal function. The promise of the continuing evolution of spinal surgery, the era of restoring spinal function, already appears on the horizon. The current state of minimally invasive spine surgery is the result of a long-lasting and consecutive development of smart technologies, along with stringent surgical training practices and the improvement of instruments and techniques. However, much effort in research and development is still mandatory to establish, maintain and evolve minimally invasive spine surgery. The education and training of the next generation of highly specialized spine surgeons is another key point. This paper will give an overview of surgical techniques and methods of the past 25 years, examine what is in place today, and suggest a projection for spine surgery in the coming 25 years by drawing a connection from the past to the future.
在脊柱外科发展的过去25年里，取得了巨大的进步。以减少手术创伤为总体目标的智能技术的发展催生了微创外科技术的概念。显微外科、内窥镜检查和各种经皮技术的改进以及植入材料的改良都已被证明是具有里程碑意义的进展。脊柱外科医生培训的进步以及将图像引导与精确的术中成像、计算机辅助和机器人辅助治疗方式相结合，构成了脊柱外科降低治疗并发症的时代。这一进展引领了目前保护脊柱功能的时代。脊柱外科持续发展的前景，即恢复脊柱功能的时代，已然初现端倪。微创脊柱外科的现状是智能技术长期持续发展、严格的手术培训实践以及器械和技术改进的结果。然而，为了建立、维持和发展微创脊柱外科，仍需要在研发方面付出大量努力。培养下一代高度专业化的脊柱外科医生是另一个关键点。本文将概述过去25年的手术技术和方法，审视当前的现状，并通过将过去与未来联系起来，对未来25年的脊柱外科发展进行展望。
