2003 Director's Summary Synopsis

SURGICAL SPINE INTERVENTIONS: ADVANCING THE TECHNOLOGIES
Barth A. Green, M.D. • Allan D.O. Levi, M.D., Ph.D. • James D. Guest, M.D., Ph.D.

While neurosurgeons Drs. Green, Levi, and Guest manage busy neurosurgical clinical practices, they also conduct research. Among this year’s reports are results from their studies to evaluate a minimally invasive surgical technique for common neurosurgical spine procedures. Spinal cord injury and other problems with the spine often require surgery to stabilize the posterior spine. A conventional surgical procedure involves making an open incision on the back of the neck and retracting muscle and tissue to expose the vertebrae. Common complications of this approach include postoperative neck pain and kyphosis (deformity).

Recently, a minimally invasive procedure using a dilating tubular retractor system was popularized for lumbar disc surgery. To determine the system’s usefulness in surgeries of the cervical spine, Miami Project researchers tested the system in human cadavers as well as in patients undergoing posterior cervical stabilization. In the cadavers, they successfully reconstructed the spines and gained a 30-40% enlargement of the spinal canal. Their results with the minimally invasive surgical technique were comparable to the conventional invasive procedures. The surgeons also performed posterior stabilization in three patients and found that while stabilization is technically possible, further research is needed to analyze how useful the tubular dilator retractor system in procedures to stabilize more than one vertebra. Based on their experience and the results of these initial studies, the surgeons suspect that the use of the dilating tubular retractor system in cervical spine procedures may be advantageous in reducing postoperative pain, shortening hospital stays, and increasing recovery time.

Synopsis Publications

 Wang MY, Prusmack CJ, Green BA, Gruen JP, Levi ADO (2003) Minimally invasive lateral mass screws in the treatment of cervical facet dislocations: Technical note. Neurosurg 52:444-447; Discussion 447-448.

 Wang MY, Green BA, Coscarella E, Baskaya MK, Levi ADO, Guest JD (2003) Minimally invasive cervical expansile laminoplasty: An initial cadaveric study. Neurosurg 52:370-373; Discussion 373.