title: Long constructs in the thoracic and lumbar spine with a minimally invasive technique.
abstract: BACKGROUND
  Literature about long implants used together with a minimally invasive spine surgery (MISS) technique is scarce. Our objective is to contribute our surgical experience in this field and to specifically focus on several technical details.
  
  
  METHODS
  A digitally-dissected canal along the paravertebral muscles was created linking the stab wounds on each side in relation with the pedicles to be cannulated. Screws were inserted following the percutaneous technique. Long rods were modelled, threaded through the extender sleeves along the paravertebral canal and pushed into the screw heads with the reduction forceps. When fusion was needed, the facet complex was decorticated with a drill. To insert a cross-link, a canal between the 2 rods was digitally created and the spinous process was drilled.
  
  
  RESULTS
  8 patients underwent surgery (age range: 25-77 years). Indications were postosteomyelitis kyphosis in 3 patients, bone tumor in 3, and spine fracture in 2. No blood transfusions were necessary during or after surgery. A cross-link was inserted in 2 patients. Posterolateral bone fusion was attempted in 4, but radiologically identifiable in none. In one patient a cantilever manoeuvre was done to correct kyphosis. Mean duration of surgery was 4 h. There were no clinical complications related to the operation or the hardware (mean follow-up of 7.14 months, range: 1-15 months).
  
  
  CONCLUSIONS
  The application of MISS techniques can be broadened to long spinal constructs to assess fractures, tumors or deformity, especially in elderly or debilitated patients. Nevertheless, posterolateral fusion is still a challenge through these limited exposures.
authors.affiliation: Neurosurgery Department, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain. hecroldan@gmail.com
authors.forename: H
authors.initials: H
authors.lastname: Roldan
authors.forename: L
authors.initials: L
authors.lastname: Perez-Orribo
authors.forename: M
authors.initials: M
authors.lastname: Spreafico
authors.forename: M
authors.initials: M
authors.lastname: Ginoves-Sierra
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*