In contrast, Rosen et al. reported their success in treating elderly patients with MEDS for lumbar stenosis with minimal complications. They evaluated 57 patients with an average age of 80.8 years with multiple medical selleck Crizotinib comorbidities. The elderly population demonstrated improved and sustained VAS, ODI, and SF-36 scores that reached statistical significance. Rosen et al. showed no operative complications and the overall minor complication rate was 2% [33]. It is our experience that minimally invasive techniques may significantly decrease morbidity in the elderly, primarily due to decreases in blood loss, soft-tissue injury, and physiological stress. Another subpopulation of patients that may benefit from MISS approaches would be the obese patients.

Obese patients tend to have longer operative times, increased blood loss, larger incisions and soft-tissue dissection for exposure, and increased perioperative complications [78]. Some authors have quoted obesity-related complications to range from 36�C67% higher than a normal BMI patient [78�C80]. Kalanithi et al. reported an absolute increase in length of hospitalization (2 extra days) and perioperative complications (6.7%) in obese patients undergoing spinal surgery in California. The majority of their complications were from wound infections and pulmonary disease [81]. In contrast, MISS approaches would employ a small incision with minimal wound exposure and decreased soft-tissue trauma. Theoretically, there would be a decreased ��potential space�� for infection with overall decreased surgical trauma. Senker et al.

treated 72 patients with an MISS approach for a transforaminal lumbar interbody fusion and decompression. 3 subgroups were created: normal BMI, overweight, and obese. With an MISS approach, Senker et al. did not find any statistical difference between the three groups in complication rate, operative time, EBL, or hospital stay [82]. Smith et al. compared 60 ��obese�� BMI patients to 51 ��normal�� BMI patients treated with MEDS for lumbar stenosis and found similar outcomes in mean operative time, EBL, length of hospital stay, or perioperative complications [74]. Thus, obese patients who may have increased comorbidities and perioperative complications from an open surgical approach may have improved outcomes with MISS. Technological advances have opened new doors for MISS approaches in treating spinal pathologies.

While the MISS technique was originally designed for microdiscectomy, the MISS philosophy has expanded in treating many diseases from different angles with similar or improved outcomes. MISS approaches are now feasible for disc herniations, central canal/foraminal stenosis,
The unique anatomy and structural support Entinostat in the thoracic spine create challenges for practitioners attempting surgery in the region.