[SENDS criteria from the diversification of MAST procedures. Implementation of preoperative simulation].

CLINICAL ISSUE

Minimal access spinal technologies (MAST) lead to a diversification of surgical procedures, which requires careful selection of the procedure and outcome monitoring. For a rational selection of the procedure simulation, endoscopy, navigation, decompression and stabilization (SENDS) criteria can be derived from the development of the MAST procedures. Preoperative simulation has diagnostic and therapeutic values. The SENDS criteria can be verified indirectly via outcome control.

STANDARD TREATMENT

Biomechanically meaningful diagnostic x-rays of the spinal segment to be surgically treated are currently carried out with the patient in inclination and reclination.

TREATMENT INNOVATIONS

Software-related preoperative simulation based on these x-ray images facilitates the selection and implementation of the MAST procedure.

DIAGNOSTIC WORK-UP: For preoperative simulation motion shots are needed in inclination, neutral position and reclination and the dimensions can be obtained using an x-ray ball or a computed tomography (CT) scan.

PERFORMANCE

The SENDS criteria are useful because established procedures based on these criteria reach a comparable outcome. Preoperative simulation appears to be a useful selection criterion.

ACHIEVEMENTS

Preoperatively it is necessary to collate patient and segment information in order to provide each patient with individualized treatment. So far there is no evidence for a better outcome after preoperative simulation but a reduction of surgery time and intraoperative radiation exposure could already be demonstrated.

PRACTICAL RECOMMENDATIONS

Minimally invasive methods should be preferred if there is a comparable outcome. The establishment of new procedures has to be accompanied by the maintenance of a spine register. Minimally invasive surgical procedures should be individualized for each patient and segment. Mobility X-ray images should be prepared for use with the preoperative simulation as the information content significantly increases with respect to the MAST procedure.