Minimally invasive spinal surgery in spinal infections – A review

The incidence of hematogenous vertebral osteomyelitis is increasing parallel to longer life expectancies, chronic disease, better diagnostic techniques, indwelling intravascular catheters and immunosuppressive therapy. In Sub-Saharan African countries the number of reported spinal tuberculosis cases has tripled secondary to the Acquired immunodeficiency syndrome pandemic. Most patients with spinal infections can be successfully treated non-operatively. Medical management is particularly successful before significant bony destruction has taken place. In patients that require surgical intervention several recent studies have shown that MISS, applied to the treatment of spinal infections, demonstrates significant advantages over the open approaches. In the thoracic spine the exact site of the focus of infection and the extent of kyphosis determines the ideal surgical approach. The following MISS approaches to the thoracic spine are currently utilized 1. Mini-thoracotomy; 2. Mini-open thoracoscopically assisted thoracotomy (MOTA); 3. Video-assisted thoracoscopic surgery (VATS); 4. Video assisted telescopic operating microscope assisted thoracotomy (VITOM thoracotomy); and 5. Percutaneous thoracic fixation. Regarding infections of the lumbar spine neurological complications are uncommon as compared to infection of the thoracic spine. Newer MISS approaches to the lumbar spine utilized in the context of lumbar tuberculosis are the MISS Transforaminal lumbar interbody fusion, MISS Extreme lateral lumbar body interbody fusion and the MISS anterior lumbar interbody fusion. The use of endoscopic spinal decompression in the management of infections of the lumbar spine is a relatively new technique and incurs inherently minimal tissue damage. Minimally invasive anterior approaches to the cervical spine are not commonly performed. MISS-microsurgical anterior approach in the context of cervical spine infection have however been reported. MISS posterior approaches to the cervical spine are also being performed. We aimed to provide a review of the MISS approaches currently in use to treat spinal infections to assist spinal surgeons whom manage this problem.