Editor: Mick J. Perez-Cruet MD
Co-Editors: Rudolf W. Beisse MD, Luiz Pimenta MD, and Daniel H. Kim MD.
Publisher: Thyme – 774 pages
Book Review by: Nano Khilnani
On spine surgery, the editor Dr. Mick J. Perez-Cruet begins this book by writing in the Preface:
Much like the cables on a suspension bridge, the paraspinal muscles and ligaments play a key role in the long-term health of the spine. The complex interactive physiology and biomechanics of the vertebrae, discs, muscles and ligaments makes preserving these structures a vital part of treating spine pathology. Disrupting one of these elements can lead to the dysfunction of another. Minimally invasive fusion techniques attempt to preserve the anatomic integrity of the spine. We have seen remarkable results from using these procedures.
Minimally invasive surgery on the spine is preferred by patients as they can get back to work or normal living much quicker. It is also preferred by surgeons because, as Dr. Perez-Cruet explains:
- “Traditional spine fusions use large midline incisions wherein the muscles and ligaments are detached from the spine, and graft material is placed between the transverse processes. These are followed by multi-segmental instrumentation. The methods can result in considerable approach-related morbidity.”
- Painful and debilitating chronic pain conditions such as arachnoiditis as well as heavy scarring develop in patients with traditional procedures
- Additional surgeries at adjacent levels to extend the fusion and instrumentation construct are required by a large percentage of patients
It is because of the above outcomes and other problems such as extensive blood loss and extended operative time, that spine surgeons realized how important it is to preserve normal spine anatomy by using less invasive methods in spine fusion.
Seventy-five specialists in minimally-invasive spine surgery, neurosurgery, orthopedic surgery, and spine surgery from all over the United States and five other countries – Brazil, Ecuador, Germany, Mexico, and South Korea – authored the 38 chapters of this book organized around five Parts that we name below
- Part I. Fundamentals
- Part II. Operative Techniques in the Lumbar Spine
- Part III. Thoracoscopic Techniques and Treatment of Degenerative Scoliosis
- Part IV. Outcomes and Complications
- New and Future Directions
Since one of the important reasons given for minimally invasive spine fusions is to preserve normal spine anatomy, let us take a closer look at the contents of chapter 4 entitled Rationale for Anatomic Spine Preservation authored by Ross R. Moquin.
He first describes the human spine as “a magnificent structure that is simultaneously flexible and stable – an elegant interaction of bones, ligaments, muscles, joints and nerves.” There are three important functions of the spine:
- It serves as the main structural support for the body
- It acts as the anchor for the limbs
- It protects the spinal cord and branching nerve roots
A strong and healthy spine, must respond well to all of the external forces applied to the body, as well as to the internal forces imposed on it as the body changes position in the environment.
Minimally invasive spine procedures have far outpaced open spine procedures, the chapter author asserts, and supports it with a simple chart showing that an overwhelming 85 percent of them are minimally invasive, while only 15 percent are open procedures.
The human spine is flexible with age. The author writes that it changes in relatively predictable ways: “Anatomic compensatory mechanisms are normally in place to help the spine adapt to changes that occur throughout the aging process. For example the lumbar spinal canal has a large diameter to accommodate the facets as they enlarge with age.” Another example of the spine’s ability to adapt is that the thecal sac that contains cerebral spinal fluid cushions the nerves as the canal becomes stenotic over time.
Ross Moquin points out three separate but closely intertwined goals in spine surgery:
- Achieving neural decompression
- Correcting or preventing any spinal deformity
- Maintaining stability.
This is an excellent textbook on minimally invasive spine fusion which has now become the most widely accepted and used method in many procedures involving the spine, over open surgery that has numerous disadvantages and shortcomings.
Editor:
Mick J. Perez-Cruet MD, MSc is Vice-Chairman and Professor in the Department of Neurosurgery at the Oakland University William Beaumont School of Medicine, and Director of the Minimally Invasive Spine Surgery and Spine Program at Michigan Head and Spine Institute in Royal Oak, Michigan
Co-Editors:
Rudolf W. Beisse MD is Adjunct Professor of Neurosurgery in the Department of Neurosurgery at the University of Utah in Salt Lake City, Utah. He is also Head of the Department at Spine Center Munich in the Orthopedic Hospital Munchen-Harlaching in Munich, Germany.
Luiz Pimenta MD, PhD is Assistant Professor in the Department of Neurosurgery at the University of California-San Diego in San Diego, California. He is also Chief of Spine Surgery in the Department of Minimally Invasive Spine Surgery at Instituto de Patologia de Coluna in Sao Paolo, Brazil.
Daniel H. Kim MD, FACS is Professor and Director of the Department of Spinal Neurosurgery and Reconstructive Peripheral Nerve Surgery in the Department of Neurosurgery at Baylor College of Medicine in Houston, Texas.
