mini-invasive fenestration of the lumbar spine through a transspinous approach pr olivier gille...
TRANSCRIPT
![Page 1: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/1.jpg)
Mini-invasive fenestrationMini-invasive fenestrationof the lumbar spine of the lumbar spine through a transspinous through a transspinous approachapproach
Pr Olivier GILLEPr Olivier GILLESpinal UnitSpinal UnitUniversity Hospital University Hospital Bordeaux FranceBordeaux France
![Page 2: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/2.jpg)
Central stenosisCentral stenosis
The laminaThe lamina– Its proximal partIts proximal part
![Page 3: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/3.jpg)
lateral recess stenosislateral recess stenosis
![Page 4: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/4.jpg)
foraminal stenosis foraminal stenosis
![Page 5: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/5.jpg)
Lumbar fenestration Lumbar fenestration described by Pr Senegas 1976described by Pr Senegas 1976
Alterations of erector spinae muscles following a posterior lumbar surgery
![Page 6: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/6.jpg)
Assessment of erector Assessment of erector spinae musclesspinae muscles
Measurement of muscular strength with force Measurement of muscular strength with force measuring devices measuring devices
Measurement of the electromyographic Measurement of the electromyographic signalsignal
Measurement of the cross-sectional area Measurement of the cross-sectional area (CSA) of the muscles(CSA) of the muscles– Ultrasound studiesUltrasound studies– CT scansCT scans– MRIMRI
Measurement of signal density (CT scans) or Measurement of signal density (CT scans) or signal intensity (MRI)signal intensity (MRI)
![Page 7: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/7.jpg)
Assessment of muscles using Assessment of muscles using MRIMRI
Measurement of muscle area on axial Measurement of muscle area on axial slidesslides
– Barker Spine. 2004Barker Spine. 2004– Parkkola Spine. 1993 Parkkola Spine. 1993 – Dangaria. Spine. 1998Dangaria. Spine. 1998
muscle signal intensitymuscle signal intensity– Visual assessment Visual assessment
– Salminen. J Spinal Disord. 1993; Parkkola R, Spine. Salminen. J Spinal Disord. 1993; Parkkola R, Spine. 19931993
– Region of interest (ROI) in the muscleRegion of interest (ROI) in the muscle– Gejo Spine 1999Gejo Spine 1999 – Kim Spine 2005Kim Spine 2005
![Page 8: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/8.jpg)
Measurement of the muscle Measurement of the muscle contractile component cross-contractile component cross-section area (CCSA)section area (CCSA)
Area measurement by surrounding the Area measurement by surrounding the musclemuscle
signal intensity determination of the signal intensity determination of the contractile tissuecontractile tissue– Using 4 ROI in plain muscular zone Using 4 ROI in plain muscular zone
In collaboration with the biomechanics Laboratory of ENSAM, Paris
![Page 9: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/9.jpg)
Measurement of the muscle Measurement of the muscle contractile component cross-contractile component cross-section area (CCSA)section area (CCSA)
![Page 10: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/10.jpg)
CCSA
CCSA NCCSA
NCCSA
Pre operative MRI
Post operative MRI
Alterations of erector spinae Alterations of erector spinae muscles following a posterior muscles following a posterior lumbar surgerylumbar surgery
![Page 11: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/11.jpg)
Following a posterior Following a posterior lumbar surgerylumbar surgery
the contractile component of the the contractile component of the erector spinae muscles decreases erector spinae muscles decreases of 25%of 25%
O.Gille, JM Vital. Erector spinae muscle changes on MRI following lumbar surgery through a posterior approach. Spine, 2008
![Page 12: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/12.jpg)
LUMBAR SPINOUS PROCESS-SPLITING LAMINECTOMY
WATANABE , 2006
![Page 13: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/13.jpg)
CHIMNEY SUBLAMINAR
DECOMPRESSION
LIN , 2006
![Page 14: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/14.jpg)
CHO : « Marmot technique » , J. Neurosurgery Spine 2007
![Page 15: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/15.jpg)
No high rate of improvementLong time surgeryTechnically difficultLong learning curve“Blind” surgeryHigh risk of nerve root or dural tear
![Page 16: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/16.jpg)
Step 1: Length spinous process measurement on preop MRI
![Page 17: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/17.jpg)
•Step 2: Spinous process osteotomy using a straight osteotom (3 mm security)
•Step 3: Osteotomy at the base of the spinous process performing with a curved osteotom.
•Step 5: The decompressive procedure can be continue as usual
•Step 4: Osteotomy of the distal part of the lamina using a curved osteotom
L4
L5
![Page 18: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/18.jpg)
OpticalOptical magnification magnification Head lightHead light Operative time < 30 mnOperative time < 30 mn No blood lossNo blood loss
![Page 19: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/19.jpg)
15 15 patientspatients Lumbar canal stenosisLumbar canal stenosis
– One levelOne level preop and 3 months postop preop and 3 months postop
MRIMRI– Quality of decompressionQuality of decompression– Assessment of muscle changesAssessment of muscle changes
![Page 20: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/20.jpg)
Measurement of the cross-sectional Measurement of the cross-sectional area of the spinal canal (T2 area of the spinal canal (T2 sequence)sequence)
Preop Postop
![Page 21: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/21.jpg)
Preop Postop
![Page 22: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/22.jpg)
ResultsResults
Preop spinal canal area : 0.8 cm²Preop spinal canal area : 0.8 cm²
Postop spinal canal area : 2.1 cm²Postop spinal canal area : 2.1 cm²
![Page 23: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/23.jpg)
Measurement of the Measurement of the MULTIFIDUS AND LONGISSIMUS MULTIFIDUS AND LONGISSIMUS contractile component cross-contractile component cross-section area (CCSA) section area (CCSA) (T1 (T1 sequence)sequence)
Preop Postop
![Page 24: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/24.jpg)
MeasurementMeasurement of the of the MULTIFIDUS AND LONGISSIMUS MULTIFIDUS AND LONGISSIMUS contractile component cross-contractile component cross-section area (CCSA) section area (CCSA) (T1 (T1 sequence)sequence)
Preop Postop
![Page 25: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/25.jpg)
ResultsResults
Following a transspinous approachFollowing a transspinous approach::– the contractile component of the the contractile component of the
erector spinae muscles decrease erector spinae muscles decrease less than 5% (Mean 4.8)less than 5% (Mean 4.8)
![Page 26: Mini-invasive fenestration of the lumbar spine through a transspinous approach Pr Olivier GILLE Spinal Unit University Hospital Bordeaux France](https://reader035.vdocuments.us/reader035/viewer/2022062304/56649f3b5503460f94c590a1/html5/thumbnails/26.jpg)
ConclusionConclusion
Advantages of fenestration through Advantages of fenestration through transspinous approach:transspinous approach:
Technically simpleTechnically simple Minimal soft tissues injuryMinimal soft tissues injury Short time surgery (< 30 mn)Short time surgery (< 30 mn) Excellent working space and visualizationExcellent working space and visualization Less bleedingLess bleeding Less postoperative pain ?Less postoperative pain ?
LimitsLimits:: Difficulties for repairing a dural tearDifficulties for repairing a dural tear