Boadi Blake I, Ikwuegbuenyi Chibuikem Anthony, Inzerillo Sean, Dykhouse Gabrielle, Bratescu Rachel, Omer Mazin, Kashlan Osama N, Elsayed Galal, Härtl Roger
Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, NY, USA.
College of Medicine, SUNY Downstate Health Sciences University, New York, NY, USA.
Neurospine. 2024 Sep;21(3):770-803. doi: 10.14245/ns.2448652.326. Epub 2024 Sep 30.
Minimally invasive spine surgery (MISS) employs small incisions and advanced techniques to minimize tissue damage while achieving similar outcomes to open surgery. MISS offers benefits such as reduced blood loss, shorter hospital stays, and lower costs. This review analyzes complications associated with MISS over the last 10 years, highlighting common issues and the impact of technological advancements.
A systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines was conducted using PubMed, MEDLINE, Embase via OVID, and Cochrane databases, covering publications from January 2013 to March 2024. Keywords related to MISS and complications were used. Studies on adult patients undergoing MISS with tubular, uniportal, or biportal endoscopy, reporting intraoperative or postoperative complications, were included. Non-English publications, abstracts, and small case series were excluded. Data on MISS approach, patient demographics, and complications were extracted and reviewed by 2 independent researchers.
The search identified 880 studies, with 137 included after screening and exclusions. Key complications in cervical MISS were hematomas, transient nerve root palsy, and dural tears. In thoracic MISS, complications included cerebrospinal fluid leaks and durotomy. In lumbar MISS, common complications were incidental dural injuries, postoperative neuropathic conditions, and disc herniation recurrences. Complications varied by surgical approach.
MISS offers reduced anatomical disruption compared to open surgery, potentially decreasing nerve injury risk. However, complications such as nerve injuries, durotomies, and hardware misplacement still occur. Intraoperative neuromonitoring and advanced technologies like navigation can help mitigate these risks. Despite variability in complication rates, MISS remains a safe, effective alternative with ongoing advancements enhancing its outcomes.
微创脊柱手术（MISS）采用小切口和先进技术，在实现与开放手术相似疗效的同时，尽量减少组织损伤。MISS具有减少失血、缩短住院时间和降低成本等优势。本综述分析了过去10年与MISS相关的并发症，突出常见问题以及技术进步的影响。
按照PRISMA（系统评价和Meta分析的首选报告项目）指南进行系统评价，使用PubMed、MEDLINE、通过OVID检索的Embase以及Cochrane数据库，涵盖2013年1月至2024年3月的出版物。使用了与MISS和并发症相关的关键词。纳入了关于接受管状、单通道或双通道内镜下MISS的成年患者的研究，这些研究报告了术中或术后并发症。排除非英文出版物、摘要和小病例系列。由2名独立研究人员提取并审查关于MISS手术方式、患者人口统计学和并发症的数据。
检索到880项研究，经筛选和排除后纳入137项。颈椎MISS的主要并发症是血肿、短暂性神经根麻痹和硬脊膜撕裂。胸椎MISS的并发症包括脑脊液漏和硬脊膜切开术。腰椎MISS常见的并发症是意外硬脊膜损伤、术后神经病变和椎间盘突出复发。并发症因手术方式而异。
与开放手术相比，MISS造成的解剖结构破坏较小，可能降低神经损伤风险。然而，神经损伤、硬脊膜切开术和内固定物误置等并发症仍然会发生。术中神经监测和导航等先进技术有助于降低这些风险。尽管并发症发生率存在差异，但随着不断进步提高其疗效，MISS仍然是一种安全、有效的替代方法。
