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  • Minimally Invasive Spine Surgery in the Pediatric Population: A Case Series

    Final Number:

    Richard P Menger MD MPA; Matthew Hefner MD; Anthony H. Sin MD

    Study Design:

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit- 2017

    Introduction: Minimally invasive spinal surgery (MIS) has historically been applied to the adult population. Almost no literature reports can be found regarding routine application of MIS techniques to spinal pathology in the pediatric population. However, due to its minimal disruption, MIS shows great promise in appropriately selected pediatric patients. Here we illustrate the patient characteristics, operative technique, and surgical outcomes for minimally invasive lumbar procedures at our institution.

    Methods: Consecutive pediatric patients undergoing elective MIS lumbar spine procedures were retrospectively analyzed from a single fellowship trained academic spinal neurosurgeon from 2008 to 2016. Information was retrieved regarding procedure and disease pathology. Descriptive data was obtained including age, sex, body mass index, insurance coverage, smoking status, and co-morbidities. Outcome measures were recorded including intraoperative complications, revision surgery, and return to function.

    Results: 16 individual patients underwent 17 procedures. The median BMI was 29.2. The range of BMI scaled from 20.8 to 41.5. Ages ranged from 12-19. Nearly 20% of the pediatric patients in our series were smokers. Most patients underwent discectomy, with L5-S1 being the most common level. One patient underwent direct pars defect repair, and another underwent recurrent discectomy. Nearly 90% of patients were complication free. One patient had a recurrent disc herniation, and another had a superficial wound infection. 82.4% patients enjoyed a full return to sports such as weight lifting, gymnastics, and contact sports. One patient required pain management to help alleviate ongoing pain. Another patient required a course of outpatient rehab to help with a foot drop pathology.

    Conclusions: Advances in MIS surgery allow for application to a wider population. Our series illustrates the effective application of MIS techniques to carefully selected pediatric patients. Emphasis is on minimal disruption. The average patient in our series was overweight and nearly 20% of the patients were smokers.

    Patient Care: This will help aid in the treatment of pediatric spinal disease. This will help in the technical application of minimally invasive spine surgery. This will help improve the usefulness of minimally invasive spine surgery in a wider patient population.

    Learning Objectives: Understand the safe and effective use of minimally invasive techniques in pediatric spine surgery. Appreciate the technical nuances of pediatric minimally invasive spinal surgery. Understand the role obesity places in pediatric spinal pathology.

    References: 1) Sarwahi, Vishal, Adam L Wollowick, Etan P Sugarman, Jonathan J Horn, Melanie Gambassi, and Terry D Amaral. 2011. “Minimally Invasive Scoliosis Surgery: An Innovative Technique in Patients with Adolescent Idiopathic Scoliosis.” Scoliosis 6 (August): 16. doi:10.1186/1748-7161-6-16. 2) Harrington, J., and P. French. 2008. “Open versus Minimally Invasive Lumbar Microdiscectomy: Comparison of Operative Times, Length of Hospital Stay, Narcotic Use and Complications.” Min - Minimally Invasive Neurosurgery 51 (1): 30–35. doi:10.1055/s-2007-1004543. 3) O’Toole, John E., Kurt M. Eichholz, and Richard G. Fessler. 2009. “Surgical Site Infection Rates after Minimally Invasive Spinal Surgery.” Journal of Neurosurgery: Spine 11 (4): 471–76. doi:10.3171/2009.5.SPINE08633. 4) Sarwahi, Vishal, Adam L Wollowick, Etan P Sugarman, Jonathan J Horn, Melanie Gambassi, and Terry D Amaral. 2011. “Minimally Invasive Scoliosis Surgery: An Innovative Technique in Patients with Adolescent Idiopathic Scoliosis.” Scoliosis 6 (August): 16. doi:10.1186/1748-7161-6-16. 5) Eisenstein S, Roberts S: Aspects of current management: The physiology of the disc and its clinical relevance. J Bone Joint Surg Br 85B:633–636, 2003. 6) Adams MA, Freeman BJC, Morrison HP, et al: Mechanical initiation of intervertebral disc degeneration. Spine 25:1625–1636, 2000. 7) Goel VK, Goyal S, Clark C, et al: Kinematics of the whole lumbar spine: Effect of discectomy. Spine 10:543–554, 1985 8) Kirkaldy-Willis WH, Farfan HF: Instability of the lumbar spine. Clin Orthop 165:110–123, 1982 9) Yorimitsu E, Chiba K, Toyama Y, et al: Long-term outcomes of standard discectomy for lumbar disc herniation: A follow-up study of more than 10 years. Spine 26:652–657, 2001. 10) “Biomechanical Testing of Pars Defect Repairs.?: Spine.” 2016. LWW. Accessed September 7. 11) Widi, Gabriel A., Seth K. Williams, and Allan D. Levi. 2013. “Minimally Invasive Direct Repair of Bilateral Lumbar Spine Pars Defects in Athletes.” Case Reports in Medicine 2013 (April): e659078. doi:10.1155/2013/659078. 12) Reitman, Charles A, and Stephen I Esses. “Direct Repair of Spondylolytic Defects in Young Competitive Athletes.” The Spine Journal 2, no. 2 (March 2002): 142–44. doi:10.1016/S1529-9430(02)00179-1.

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