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박상민,윤명수,김주은,서승표,박진성,임수택,최소침습 척추치료 연구그룹 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.1
연구계획: 문헌고찰목적: 최소 침습적인 요추 재수술 방법을 소개하고, 기존에 발표된 논문을 분석하고자 한다. 선행 연구문헌의 요약: 최근 척추 수술의 빈도가 증가하면서 요추 재수술의 빈도가 증가하고 있다. 다양한 최소 침습적 기법을 이용한 재수술이 시도되고있으며, 그 중에서도 기존 수술 부위를 피하기 위해 전방 또는 측면 접근과 내시경적 수술 방법을 선호하는 경향이 있다. 대상 및 방법: 관련 연구 고찰결과: 내시경적인 방법으로는 단일공 내시경과 양방향 내시경이 많이 사용되고 있다. 두 가지 수술 모두 요추 재수술에서 사용할 수 있으며 특히 추간판절제술 및 후궁절제술에서 많이 사용된다. 양방향 내시경의 경우에는 후궁절제술 후 재수술로 유합술을 이용하는 경우에도 적용이 가능하다. 원통형 견인기는 주로 최소침습적 경추간공 요추 추체간 유합술 때 많이 사용하고 있으며 후궁절제술 후 재발이나 추간판 탈출증 재탈줄 시 유합술로 변경하는 경우 많이 사용한다. 측방 접근 방법도 사용하는 경우도 많으며 특히 후방의 유착이 심할 것으로 예상되는 경우 많이 사용하고 있다. 결론: 척추 재수술은 척추 의사에게 피할 수 없는 수술이며 이를 해결하기 위한 다양한 수술 방법들이 있다. 고식적인 방법을 통해 수술하는 것이 원칙이지만, 최근 소개된 다양한 최소침습적인 방법들도 환자에게 유용한 치료 방법으로 생각된다.
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박상민,홍재영,박시영,손은석,임수택,최소침습 척추치료 연구그룹 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.4
Study Design: Review article. Objectives: To introduce the past and present of minimally invasive spine surgery, as well as future developments. Summary of Literature Review: Spine surgery has evolved into a minimally invasive surgical procedure that requires skin incisions that are as small as possible. This has become a topic of interest for both patients and doctors, as it not only solves cosmetic problems by reducing skin incisions, but also reduces postoperative pain and complications by preserving as much normal tissue as possible while reducing blood loss, shortens the recovery period, and facilitates the return to normal life. At the same time, the surgical instruments required for minimally invasive surgery are being actively developed. Materials and Methods: Review of the relevant articles Results: The history of minimally invasive techniques is well described in the evolution of the surgical treatment of lumbar disc herniation. Minimally invasive lumbar discectomy began in the early 20th century, and many advances were made with the development of microscopes and tubular retractors. The development of endoscopes also led to the popularization and use of minimally invasive surgery. Minimally invasive surgery is also used in the thoracic and cervical spine, but many advances remain to be made in the lumbar spine. More recently, technologies such as navigation, robotics, and augmented reality have been developed and are helping to improve the safety of minimally invasive spine surgery. Conclusions: Minimally invasive spine surgery is rapidly evolving with recent technological advances. Advances in technology are expected to compensate for the limitations of minimally invasive surgery, and it is likely to become an alternative to traditional surgery for a variety of spinal diseases.
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박상민,서승표,백종민,권기연,장해동,임수택,최소침습 척추치료 연구그룹 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.3
Study Design: Review article. Objectives: The purpose of this study was to review the perioperative considerations for lumbar fusion surgery. Summary of Literature Review: With an aging population, degenerative lumbar spine diseases are on the rise. The number of patients who have comorbidities and undergo complex lumbar spine surgery is also increasing. There are many points to consider before and after lumbar fusion surgery. Materials and Methods: Review of the relevant articles. Results: In spine surgery, conservative treatment is often considered before surgical treatment because symptoms often improve with conservative treatment. If conservative treatment fails, surgical treatment is then considered. Once the decision to operate has been made, the patient's past medical history is taken, and medical conditions are assessed before surgery. The severity of osteoporosis is also assessed to determine the surgical approach. If severe osteoporosis is present, osteoporosis treatment may be considered first, and if it is very severe, various pedicle screw fixation techniques should be considered. Finally, a multidisciplinary approach to surgery is necessary to ensure rapid recovery. Enhanced recovery after surgery (ERAS) protocols have recently been applied to lumbar fusion surgery. Conclusions: Adequate and appropriate conservative treatment should be implemented before spine surgery. Medical risk factors (diabetes, smoking, osteoporosis, kidney disease, medications, etc.) should be identified and corrected preoperatively. In addition, early patient recovery with perioperative ERAS should be considered, as ERAS protocols may have a positive effect in older patients with a higher frequency of postoperative complications.
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박상민,박현진,구기형,홍재영,임수택,최소침습 척추치료 연구그룹 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.1
Study Design: Review article Objectives: To introduce minimally invasive surgical (MIS) techniques and to review previous studies about these techniques. Summary of Literature Review: Recent trends indicate an increase in the use of MIS for spinal fusion. According to reports, MIS reduces postoperative morbidity, with surgical outcomes comparable to those of conventional spine surgery. Furthermore, there are reportedly fewer complications and pain after surgery, resulting in a rapid return to everyday life. Materials and Methods: A review of the relevant articles. Results: MIS techniques, such as biportal endoscopy, the use of a tubular retractor, and the anterior approach, have recently become increasingly popular. Access to the intervertebral disc through the intervertebral foramen is a characteristic shared by biportal endoscopy and the use of a tubular retractor. Numerous investigations have demonstrated that procedures employing a tubular retractor yield clinical and radiographic outcomes comparable to those of conventional open spine surgery. Biportal endoscopy is still undergoing clinical investigations, and its safety and efficacy have not yet been established. Anterior approach fusion is mainly used in patients with mild central canal stenosis; thus, its indications are somewhat limited compared to conventional posterior fusion. However, additional decompression after anterior approach fusion allows both direct and indirect decompression to be obtained. Conclusions: With MIS, patients’ satisfaction after surgery is high due to the small amount of bleeding during surgery and limited damage to surrounding anatomical structures. However, these MIS techniques have narrow indications, and we must accurately understand the disadvantages and limitations of each technique.
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