Mick Perez-Cruet

By Namath S. Hussain, Vickram Tejwani and Mick Perez-Cruet

Part of the book: Tissue Regeneration

By Mick Perez-Cruet, Ramiro Pérez de la Torre and Siddharth Ramanathan

Minimally invasive spine surgery (MIS) transforaminal lumbar interbody fusion (MI-TLIF) has been utilized to treat a variety of spinal disorders. Like other minimally invasive spine surgery techniques and technology, the MI-TLIF approach has the potential to limit the morbidity associated with larger exposures required for open surgery. The MI-TLIF approach has a number of advantages over many other minimally invasive spine surgery approaches including direct decompression of neural elements, collection of morselized autograph from the surgical site to achieve high fusion rates, restoration of spinal canal diameter, foraminal diameter, disk height, and reduction of spondylolisthesis. In this chapter, we discuss a novel technique for performing MI-TLIF developed by the senior author who is a leading minimally invasive spine surgeon. The technique and technology illustrated in this chapter were developed out of a recognition of a need to reduce the learning curve for performing MI-TLIF, as well as need for a cost-effective method that provides a high fusion rate, excellent clinical outcomes, and low complication rate. The indications, surgical planning, postoperative care, complications, and patient outcomes in a large series will be reviewed using this novel MI-TLIF technique.

Part of the book: Minimally Invasive Spine Surgery

By Mick Perez-Cruet, Ramiro Pérez de la Torre and Siddharth Ramanathan

Lumbar stenosis is the most common pathology seen and treated by spine surgeons. It is often seen in the elderly population who frequently have multiple medical co-morbidities. Traditional approaches remove the spinous process and detach paraspinous muscles to achieve adequate canal decompression. This approach can damage the posterior tension band leading to permanent muscle damage, scar tissue formation, iatrogenic flatback syndrome, and increase risk of adjacent segment disease requiring reoperation. Performing lumbar laminectomy in a cost-effective manner is critical in effectively treating patients with lumbar stenosis. This chapter reviews a minimally invasive muscle-sparing approach to treating lumbar stenosis. The technique is performed through a tubular retractor. Direct decompression of the spinal stenosis is achieved while preserving the paraspinous muscle attachments and spinous process. This technique has multiple advantages and can potentially reduce load stress on adjacent levels and subsequent adjacent level pathology leading to further surgical intervention. In addition, the procedure shows how facet fusion is performed using the patient’s own locally harvested drilled morselized autograph to achieve bilateral facet fusion. By fusing the facets, we have shown that restenosis at the operative level is less likely to occur. This chapter will review a case series of multilevel lumbar stenosis including clinical outcomes.

Part of the book: Minimally Invasive Spine Surgery

By Mick Perez-Cruet and Lee-Onn Chieng

Substantial evidence exists supporting lumbar fusion procedures in cases of spondylolysis, spondylolisthesis, and other cases of sagittal deformity. However, coronal deformity can also be a cause of low back and leg pain. One hundred seven patients underwent minimally invasive transforaminal lumbar interbody fusion (MITLIF). All patients had preoperative and postoperative radiographs exhibiting a clear coronal deformity that correlated with their symptomatology. Dynamic radiographs were analyzed using a three-point angle measurement tool through the EasyViz viewer program. Pre-op and post-op Cobb angles (CA) were recorded along with Health-related Quality of Life (HRQL) measures, Visual Analog Scale, Oswestry Disability Index, and SF-36. The average CA decreased from 9.47 pre-op to 7.54 post-op (p < 0.05). CA ranged from 0.7 to 43.2% pre-op, and 0.7 to 34.1% post-op. There was a statistically significant (p < 0.05) correlation between CA improvement and HRQL measure improvement. There has not been an appropriate level of focus on coronal deformity, its relationship to HRQL measures, and long-term prognosis. In our study, CA was reduced by 21% on average with just a single-level fusion, supporting the consideration of a focused single-level fusion versus a large multilevel fusion in cases of coronal deformity, especially in elderly patients.

Part of the book: Adult and Pediatric Spinal Deformities