Minimally Invasive Approach for the Treatment of Intradural Spinal Pathology

Ravi H. Gandhi, M.D; John W. Germ an, M.D.


Neurosurg Focus. 2013;35(2):e5 

In This Article


Through a retrospective review of a prospectively collected surgical database, we identified 26 patients who underwent 27 surgeries via an MIS approach for intradural pathology of the spine. All patients underwent a physical examination and findings were correlated with preoperative imaging. Institutional review board approval was obtained from Albany Medical College.

Details regarding the operation, including duration, estimated blood loss, and need for transfusion were prospectively recorded. Postoperative images were obtained and reviewed when appropriate based on pathology. Information about operative and postoperative complications including CSF leakage, readmission, return to the operating room, infection, and increased neurological deficit was also recorded and analyzed.

In the thoracolumbar spine, a K-wire was used to localize the correct level on fluoroscopy. After infiltrating the skin with lidocaine, a 2- to 2.5-cm paramedian incision was created, and an expandable tubular retractor (Quadrant Retractor, Medtronic Sofamor-Danek) was placed over sequential dilators using a muscle-splitting technique. In the cervical spine, a midline incision was created and a lateral fascial incision was made. Next a muscle-splitting dissection was carried out down to the lamina and sequential dilators were placed. The bone removal was carried out with the use of high-speed drills and Kerrison rongeurs. Once the dura was incised and the leaflets were tacked up, the intradural pathology was treated using a microsurgical technique. The dura was closed primarily or using a dural substitute. The dural suture line was then covered with a dural sealant.

All patients were then mobilized within 24 hours after surgery. Postoperative imaging was performed when indicated based on the pathology.