Preface

Advances in minimally invasive spine surgery (MIS) have improved patient outcomes for a variety of pathologies affecting the spinal column. These advances all have the same goal, which is to improve patient outcomes by reducing approach-related morbidity. Patients can have quicker recoveries and return to normal active lifestyles by preserving the normal anatomical structures and or motion of the spine when performing spine surgery. These goals are increasingly becoming the required objectives of patients when seeking out surgeons to perform their spine procedures. Those surgeons who know how to treat patients in a minimally invasive fashion will grow their practices and help many suffering patients effectively. There has been a boom in MIS treatments and advancements in this area have accelerated rapidly. This book teaches physicians how to treat patients using MIS, improve outcomes, and quickly return patients to full and active lifestyles.

In this book, we list some of the latest advancements and developments in MIS. This is by no means a complete textbook on MIS and additional materials are needed to keep up with this rapidly advancing field.

The first section begins with chapters on cervical approaches, including outpatient cervical arthroplasty as well as novel arthroplasty devices that mimic the true motion of the human cervical spine. These newer technologies allow for motion in all six planes including flexion, extension, lateral rotation, and compression. The intervertebral disc is not a ball and socket joint like the hip or knee; therefore, for arthroplasty devices to truly work, compression and limited motion as seen in the anatomical annulus fibrosis and nucleus pulposus of the intervertebral disc should be reproduced in an arthroplasty device.

In the second section, chapters discuss minimally invasive and novel approaches for treating the pathology of the thoracic spine.

In the third section, chapters address minimally invasive lumbar approaches. This is the largest section since most surgical pathology we treat is in the lumbar spine. It discusses novel minimally invasive approaches that treat very common spinal conditions like lumbar stenosis and spondylolisthesis. These approaches preserve the normal anatomy of the lumbar spine, including the spinous processes and the paraspinal muscle attachments to the spinous process and lamina. This is critical in preventing stresses on adjacent levels, which can lead to joint and ligamentum flavum hypertrophy requiring additional and costly reoperations. Patients clearly recover faster and return to active lifestyles with these procedures that preserve much of the normal anatomy and function of the lumbar spine. Though we still do not entirely understand the underlying physiological etiology of spinal stenosis, fusing the segment while preserving much of the normal anatomy of the spine, as is explained in this book, can lead to long-lasting, excellent outcomes for these patients. This includes those patients suffering from multi-segmental spinal stenosis. The traditional procedures where the spinous process is removed over

multiple segments can lead to high rates of adjacent segment disease, scarring, and failed laminectomy syndrome. This can result in considerable patient suffering and poor outcomes. If the content of this book can help these patients alone, then it has achieved a major goal in advancing the spine field.

The fourth section includes one chapter on treating spinal malignancy in a minimally invasive fashion. This chapter not only explores novel approaches but also focuses on treatment that can help to reduce morbidity while improving survival and outcomes for patients suffering from spinal malignancy.

The final section on minimally invasive assisted robotic spine surgery (MARSS) is a rapidly growing area in MIS. Using robots, spinal instrumentation can be applied accurately and precisely while preserving the normal anatomical structures of the spine. Indeed, more recent technology is advanced to the point where the surgeon can literally peer through the spine as if having x-ray vision. The result is that there is no longer a need to strip away and destroy critical anatomical structures of the spine like muscles, ligaments, bones, and joints to view the bony anatomy. These structures are critical to the long-term health of the spine and preserving their form and function can greatly improve patient outcomes, reduce the need for reperforming spine surgery, and quickly returns patients to their full and active lifestyles, which is the ultimate goal.

> **Mick Perez-Cruet, MD, MS** Vice Chairman and Professor, Director, Minimally Invasive Spine and Spine Program, Department of Neurosurgery, Oakland University William Beaumont, School of Medicine, Auburn Hills, Michigan

> > Department of Neurosurgery, Michigan Head and Spine Institute, Southfield, Michigan, USA

Section 1
