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CLINICAL UPDATE
Minimally invasive spine surgery By Dr Paul Taylor & Dr Greg Cunningham, Spine Surgeons, Murdoch The principal goals of minimally invasive spine surgery (MISS) are to reduce surgical morbidity and recovery period of surgery. For most procedures, this comes down to two discrete elements. Firstly, to reduce the extent of the surgical dissection such as the traditional “stripping” of the spine for posterior fusion in which erector spinae musculature is dissected off the vertebrae to be fused (Fig 1a), and, secondly, to reduce blood loss therefore reducing the physiological insult of the surgery and the length of recovery. The reduced physiological insult of MISS has made surgical treatment suitable to some candidates not deemed fit for traditional open approaches. Early development saw sequential
Key messages
MISS aims to reduce tissue damage and blood loss, thereby shortening recovery It comprises a suite of techniques with technology dependent procedures and significant learning curves to address spinal pathology Not all pathologies or patients are suitable for MISS techniques.
muscle dilating probes used with tubular table-mounted retractors allowing access to many parts of typically the posterior spine throughout its length without substantial dissection. Using an operating microscope and typically custom-designed instrumentation to reduce visual obstruction,
lumbar and cervical discectomy, lumbar central canal stenosis decompression procedures were offered, typically through a 16mm or 18mm diameter tube retractor. Placing pedicle screw instrumentation into the spine was traditionally performed ‘open’. Techniques using cannulated equipment to deliver screws percutaneously (essentially using a Seldinger technique of wire placement into a pedicle and then placing a screw over that wire) began the treatment of some fractures and tumours with pure percutaneous rod and screw placement, and, along with the use of tubular retractors, began the development all MIS lumbar fusion techniques. Over the past decade, many techniques have developed,
Breast screening resumes
B
reastScreen WA (BSWA) - the state’s breast cancer screening program - has resumed mammogram screening services.
The metropolitan clinics were the first to re-open, with screening in rural areas restarting in early June 2020. Women who were invited to have a screening mammogram before the temporary suspension in April were prioritised and received the first available appointment. Other women are encouraged to book online or contact BSWA on 13 20 50 to schedule their appointment.
Women may book online www.breastscreen.health.wa.gov.au or phone 13 20 50 42 | JUNE 2020
Mar ‘18
BSWA’s Medical Director Dr Liz Wylie said she welcomed the reopening of BSWA’s screening services: “We will be booking clients based on clinical priority to ensure those who are most in need are screened first. The safety of our clients and staff remains of paramount importance and we will continue to ensure the highest levels of hygiene and care. We thank all our clients and GPs for their patience and understanding during this time.”
MEDICAL FORUM | MENTAL HEALTH ISSUE
