Advanced Minimally Invasive Techniques: Management of High-grade Spondylolisthesis and Thoracic Metastatic Spinal Disease

Abbas Naqvi, Mohamed Noureldin, Islam M. Elboghdady, Khaled Aboushaala, Eric Sundberg, Hamid Hassanzadeh, Kern Singh


Recentadvances in spine surgery technology and instrumentation have allowed for the development of minimally invasive (MIS) techniques. These muscle-sparing approaches have been demonstrated to provide superior, if not similar, outcomes to traditional open techniques. However, MIS techniques are associated with a steep learning curve and greater radiation exposure. Furthermore, while suitable for most degenerative spinal conditions, MIS approaches may not be appropriate for complex spinal pathology. This articlediscusses the literature onopen and advanced MIS techniques for high-grade isthmic spondylolisthesis and metastatictumors of the thoracic spine. Additionally, the authors’ preferred techniques along with their associated pearls and pitfalls are presented for both complex pathologies.


Minimally Invasive Techniques; MIS; High-grade; Isthmic Spondylolisthesis; Thoracic Tumor; Lateral Retropleaural; Corpectomy; Transforaminal Lumbar Interbody Fusion; TLIF

Full Text:



Birkenmaier C. Expert's comment concerning Grand Rounds case entitled "Minimal access bilateral transforaminal lumbar interbody fusion for high-grade isthmic spondylolisthesis" (by Nasir A. Quraishi and Y. Raja Rampersaud; doi:10.1007/s00586-012-2623-2). Eur Spine J. Aug 2013;22(8):1714-1716.

Kim CW, Siemionow K, Anderson DG, Phillips FM. The current state of minimally invasive spine surgery. J Bone Joint Surg Am. Mar 16 2011;93(6):582-596.

Quraishi NA, Rampersaud YR. Minimal access bilateral transforaminal lumbar interbody fusion for high-grade isthmic spondylolisthesis. Eur Spine J. Aug 2013;22(8):1707-1713.

Shedid D, Weil AG, Lieberman I. A novel minimally invasive technique for the treatment of high-grade isthmic spondylolisthesis using a posterior transsacral rod. J Spinal Disord Tech. Apr 2014;27(2):E41-48.

Shunwu F, Xing Z, Fengdong Z, Xiangqian F. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine (Phila Pa 1976). Aug 1 2010;35(17):1615-1620.

Jones TR, Rao RD. Adult isthmic spondylolisthesis. J Am Acad Orthop Surg. Oct 2009;17(10):609-617.

Molinari RW, Bridwell KH, Lenke LG, Baldus C. Anterior column support in surgery for high-grade, isthmic spondylolisthesis. Clin Orthop Relat Res. Jan 2002(394):109-120.

Wang SJ, Han YC, Liu XM, et al. Fusion techniques for adult isthmic spondylolisthesis: a systematic review. Arch Orthop Trauma Surg. Jun 2014;134(6):777-784.

H M. Spondylolisthesis: surgical treatment and results. Surg Gynecol Obstet. 1932;54:371-377.

Hu SS, Bradford DS, Transfeldt EE, Cohen M. Reduction of high-grade spondylolisthesis using Edwards instrumentation. Spine (Phila Pa 1976). Feb 1 1996;21(3):367-371.

Hart RA, Domes CM, Goodwin B, et al. High-grade spondylolisthesis treated using a modified Bohlman technique: results among multiple surgeons. J Neurosurg Spine. May 2014;20(5):523-530.

Transfeldt EE, Mehbod AA. Evidence-based medicine analysis of isthmic spondylolisthesis treatment including reduction versus fusion in situ for high-grade slips. Spine (Phila Pa 1976). Sep 1 2007;32(19 Suppl):S126-129.

Min JH, Jang JS, Lee SH. Comparison of anterior- and posterior-approach instrumented lumbar interbody fusion for spondylolisthesis. J Neurosurg Spine. Jul 2007;7(1):21-26.

Hironaka Y, Morimoto T, Motoyama Y, Park YS, Nakase H. Surgical management of minimally invasive anterior lumbar interbody fusion with stand-alone interbody cage for L4-5 degenerative disorders: clinical and radiographic findings. Neurologia medico-chirurgica. 2013;53(12):861-869.

Barron KD, Hirano A, Araki S, Terry RD. Experiences with metastatic neoplasms involving the spinal cord. Neurology. Feb 1959;9(2):91-106.

Keshavarzi S, Park MS, Aryan HE, et al. Minimally invasive thoracic corpectomy and anterior fusion in a patient with metastatic disease: case report and review of the literature. Minim Invasive Neurosurg. Jun 2009;52(3):141-143.

Schaberg J, Gainor BJ. A profile of metastatic carcinoma of the spine. Spine (Phila Pa 1976). Jan-Feb 1985;10(1):19-20.

Walsh GL, Gokaslan ZL, McCutcheon IE, et al. Anterior approaches to the thoracic spine in patients with cancer: indications and results. Ann Thorac Surg. Dec 1997;64(6):1611-1618.

Scheufler KM. Technique and clinical results of minimally invasive reconstruction and stabilization of the thoracic and thoracolumbar spine with expandable cages and ventrolateral plate fixation. Neurosurgery. Oct 2007;61(4):798-808; discussion 808-799.

Dajczman E, Gordon A, Kreisman H, Wolkove N. Long-term postthoracotomy pain. Chest. Feb 1991;99(2):270-274.

Dakwar E, Ahmadian A, Uribe JS. The anatomical relationship of the diaphragm to the thoracolumbar junction during the minimally invasive lateral extracoelomic (retropleural/retroperitoneal) approach. J Neurosurg Spine. Apr 2012;16(4):359-364.

Khoo LT, Beisse R, Potulski M. Thoracoscopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases. Neurosurgery. Nov 2002;51(5 Suppl):S104-117.

Landreneau RJ, Hazelrigg SR, Mack MJ, et al. Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. Dec 1993;56(6):1285-1289.

Ogden AT, Eichholz K, O'Toole J, et al. Cadaveric evaluation of minimally invasive posterolateral thoracic corpectomy: a comparison of 3 approaches. J Spinal Disord Tech. Oct 2009;22(7):524-529.

Karikari IO, Isaacs RE. Anterior Thoracic Approaches for Disk Disease, Tumor, or Trauma. In: Sandhu FA, Voyadzis JM, Fessler RG, eds. Decision Making for Minimally Invasive Spine Sirgery. New York: Thieme; 2011:50-59.

Uribe JS, Dakwar E, Cardona RF, Vale FL. Minimally invasive lateral retropleural thoracolumbar approach: cadaveric feasibility study and report of 4 clinical cases. Neurosurgery. Mar 2011;68(1 Suppl Operative):32-39; discussion 39.

Kasliwal MK, Deutsch H. Minimally invasive retropleural approach for central thoracic disc herniation. Minim Invasive Neurosurg. Aug 2011;54(4):167-171.

Singh K, Vaccaro AR. Pocket atlas of spine surgery. New York: Thieme; 2012.

Yoon ST, Sanfilippo JA. Open Transthoracic Corpectomy/Fusion. In: Wang JC, ed. Advanced Reconstruction: Spine. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2011:331-338.

Smith ZA, Li Z, Chen NF, Raphael D, Khoo LT. Minimally invasive lateral extracavitary corpectomy: cadaveric evaluation model and report of 3 clinical cases. J Neurosurg Spine. May 2012;16(5):463-470.



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

e-ISSN 2409-5141
Asia Press
Asia Press is a professional Science, Technology and Medicine publisher, who owns rapid publication, Peer-Reviewed, Open Access Journals. Asia Press aims to promote “knowledge sharing”. As you know, the main barrier for free “knowledge sharing” is the cost of publishing and transfer. In order to encourage scholars and scientists to the max, and devote whole power to realize the aim of “knowledge sharing” and the benefit of “all” mankind, Asia Press performs a permanent policy of no charge for publication and access, and always open its door for authors worldwide.
© 2013-2017 by the Asia Press. All rights reserved.