• Journal of Korean Neurosurgical Society
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• 제40권4호
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• pp.296-299
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• 2006

Recently the trend of surgical procedure for treatment of lumbar benign disease is a minimally invasive surgery due to small incision, minimal blood loss, and a short hospital day. By using a microscope or an endoscope, and other surgical equipment, a delicate manipulation in a narrow space became feasible, consequently, to secure a wider view with small incision, appropriate retractors are required. But the various tubular retractor systems are expensive and have some problems. We modified Thoracoport [Auto Suture Co., Norwalk, CT] by making a window at the distal end of trocar and used it as a tubular retractor in surgical procedure for treatment of lumbar benign disease. This modified tubular retractor is docked closely on the curved lamina and provides a wider view. We used it as a tubular retractor also in lumbar bilateral decompression involving a unilateral approach. But this trocar has the limited sizes [diameter and length], and also it is difficult to fix the retractor or change the direction of retractor. And then, we propose a more modified Thoracoport with various sizes and attaching the settling holders to the head of tubular retractor to be able to fix the retractor.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.245-250
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• 2007

Tubular retractor system as a minimally invasive surgery (MIS) technique has many advantages over other conventional MIS techniques. It offers direct visualization of the operative field, anatomical familiarity to spine surgeons, and minimizing tissue trauma. With technical advancement, many spinal pathologies are being treated using this system. Namely, herniated discs, lumbar and cervical stenosis, synovial cysts, lumbar instability, trauma, and even some intraspinal tumors have all been treated through tubular retractor system. Flexible arm and easy change of the tube direction are particularly useful in contralateral spinal decompression from an ipsilateral approach. Careful attention to surgical technique through narrow space will ensure that complications are minimized and will provide improved outcomes. However, understanding detailed anatomies and keeping precise surgical orientation are essential for this technique. Authors present the technical feasibility and initial results of use a tubular retractor system as a minimally invasive technique for variaties of spinal disorders with a review of literature.

• Journal of Korean Neurosurgical Society
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• 제52권4호
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• pp.427-431
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• 2012

Conventional laminectomy is the most popular technique for the complete removal of intradural spinal tumors. In particular, the central portion intramedullary tumor and large intradural extramedullary tumor often require a total laminectomy for the midline myelotomy, sufficient decompression, and adequate visualization. However, this technique has the disadvantages of a wide incision, extensive periosteal muscle dissection, and bony structural injury. Recently, split-spinous laminectomy and tubular retractor systems were found to decrease postoperative muscle injuries, skin incision size and discomfort. The combined technique of split-spinous laminectomy, using a quadrant tube retractor system allows for an excellent exposure of the tumor with minimal trauma of the surrounding tissue. We propose that this technique offers possible advantages over the traditional open tumor removal of the intradural spinal cord tumors, which covers one or two cervical levels and requires a total laminectomy.

• Journal of Korean Neurosurgical Society
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• 제56권3호
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• pp.237-242
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• 2014

Objective : The purpose of this study was to investigate the clinical features and outcomes of pediatric cavernous malformation (CM) in the central nervous system. Methods : Twenty-nine pediatric patients with supratentorial CM underwent microsurgical excision. In selected cases, transparent tubular retractor system (TTRS) was used to reduce retraction injury and intraoperative neuromonitoring (IONM) was held to preserve functioning cortex. Patients' demographics and symptoms were reviewed and surgical outcomes were discussed. Results : The main initial clinical manifestations included the following : seizures (n=13, 45%), headache (n=7, 24%), focal neurological deficits (n=3, 10%), and an incidental finding (n=6, 21%). Overt hemorrhage was detected in 7 patients (24%). There were 19 children (66%) with a single CM and 10 (34%) children with multiple CMs. In 7 cases with deep-seated CM, we used a TTRS to minimize retraction. In 9 cases which location of CM was at eloquent area, IONM was taken during surgery. There was no major morbidity or mortality after surgery. In the 29 operated children, the overall long-term results were satisfactory : 25 (86%) patients had no signs or symptoms associated with CMs, 3 had controllable seizures, and 1 had mild weakness. Conclusion : With the assistance of neuronavigation systems, intraoperative neuromonitoring, and TTRS, CMs could be targeted more accurately and excised more safely. Based on the satisfactory seizure outcome achieved, complete microsurgical excision in children is recommended for CMs presenting with seizures but removal of hemosiderin-stained areas seems to be unnecessary.

• 대한정형외과학회지
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• 제54권3호
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• pp.211-218
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• 2019

추간판 탈출증이란 추간판이 정상적으로 위치해야 할 자리에서부터 추간판 내부의 수핵이나 섬유륜이 탈출하는 질환을 지칭하며, 대부분 양호한 자연 경과를 거친다. 하지만 심각한 신경학적 증상이 있거나, 악화되는 신경 증상, 마미 증후군이 동반된 경우, 보존적 치료에 반응하지 않는 경우 등에 대해서는 수술적 치료가 권고된다. 수술 방법에는 고식적인 관혈적 방법, 현미경을 이용한 방법, 통형 견인기(tubular retractor)를 이용한 방법, 그리고 내시경을 이용한 방법에 이르기까지 다양한 방법들이 소개되었는데, 그 중 현미경적 추간판 제거술이 현재 표준 치료로 간주되고 있다. 내시경을 이용한 방법 중에서 두 개의 입구를 통한 내시경 척추 수술(biportal endoscopic spinal surgery, BESS)의 경우, 다른 방법에 비해 수술 기구들의 독자적인 움직임이 가능하여 자유로운 조작이 가능하며, 재발된 추간판 탈출증에 대해서도 추간판 제거가 비교적 수월하게 시행되고, 작은 피부 절개로 넓은 시야 확보가 가능하며, 지속적인 생리식염수의 세척으로써 습기나 안개를 지속적으로 제거해야 되는 번거로움을 덜 수 있고 술 후 감염률을 낮추는 효과도 있다. 기존의 관절경 및 척추 수술 기구들을 그대로 쓸 수 있다는 장점도 있으며, 약 2,700-6,700 lux의 밝은 조도 하에 최대 28-35배로 확대된 영상으로 수술하기 때문에 섬세한 조작이 가능하다. 따라서 이러한 장점을 지닌 두 개의 입구를 통한 BESS는 요추부 추간판 탈출증에 대한 이상적인 수술 방법으로 생각된다.

• Journal of Korean Neurosurgical Society
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• 제40권6호
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• pp.406-411
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• 2006

Objective : The authors have developed a procedure, termed posterior microscopic lesionectomy, that creates a minimal laminotomy site according to the location of the shifted disc using the $METRx^{TM}$ system in the lumbar spine. This study compared the usefulness and surgical outcomes of this procedure with those of traditional standard lumbar discectomy. Methods : From June 2003 to June 2004, Twenty-two patients with one-level radiculopathy due to lumbar disc herniation underwent posterior microscopic lesionectomy with the assistance of an operating microscope and the $METRx^{TM}$ tubular retractor. Surgical results of the new procedure were compared to those of 39 patients who underwent traditional lumbar discectomy from April 2003 to September 2004. All patients were evaluated for pain score, clinical assessment according to the VAS, and Roland-Morris scores pre-operatively and at 1, 3, 6, and 12 months post-operatively. Results : Mean blood loss, operation time, and admission date showed significant improvements for microscopic lesionectomy compared to traditional lumbar discectomy [P < 0.001]. Also, both measures of short-term functional improvement, the Visual Analogue Scale[VAS] and Roland-Morris[RM] scores, were statistically better for microscopic lesionectomy than for traditional discectomy [P < 0.001]. Conclusion : Posterior microscopic lesionectomy can be performed more safely and provide greater benefit than traditional discectomy. The procedure is associated with less post-operative pain, shorter hospital stays, and quicker rehabilitation.

• Journal of Korean Neurosurgical Society
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• 제48권3호
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• pp.219-224
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• 2010

Objective : A minimally invasive transforaminal lumbar interbody fusion (MIS TLlF) has recently been introduced. However, MIS TLlF is a technically challenging procedure. The authors performed retrospective analysis about MIS TLlF using a single interbody cage. Methods : Twenty-eight consecutive patients were treated by MIS TLlF. Of these 28 patients, 20 patients were included in this retrospective study. Perioperative, clinical, and radiologic outcomes were assessed. Clinical outcomes were assessed using Oswestry Disability Index (ODI) and Visual Analogue Scores (VAS). Fusion rates and cross-sections of operated spinal canals were assessed by CT. Results : Twelve patients underwent MIS TLlF at one segment and 8 patients at two segments (L3/4: 4, L4/5: 17, L5/S1: 7). Operation time for a single segment was 131.7 min and for two segment was 201.4 min, and corresponding blood losses were 208.3 mL and 481.2 mL, respectively. ODI and VAS scores were significantly improved at 6 months postop (ODI from 30.32 to 15.54, VAS from 7.80 to 2.20, p = 0.001) Twenty-two segments (78.6%) achieved grade I fusion, 4 segments (14.3%) achieved grade II, 2 segments (7.1%) achieved grade III and 0 segments achieved grade IV at 12 months. Postoperatively at 12 months, spinal canal cross sectional areas at disc spaces significantly increased from 157.5 to $294.3\;mm^2$ (p = 0.012). Conclusion : MIS TLlF achieved good clinical outcomes and high fusion rates. Our findings show that MIS TLlF performed with a single Interbody cage and a tubular retractor system can be used as a standard MIS TLlF technique.