Spinal Abnormalities

As with vascular lesions, many minimally invasive spine procedures mimic those in the adult population and do not need special attention in this chapter. However, some spine pathologies are specific to children. Intrauterine myelomeningocele closures are changing the face of traditional spinal surgery and perhaps blurring the boundaries of disease as we have the opportunity to intervene so early that the sequelae of disease do not even develop. In many respects this would be minimally invasive, but the hypothesis remains to be proved. In addition, it introduces ethical issues, as what may be less invasive for the baby is clearly maximally invasive for the mother.

In the authors' personal experience, tethered cord release is becoming significantly less invasive. Procedures for filar lipomas, done previously with large incisions and laminectomies, are now done microscopically with small incisions and operating between adjacent lamina. It remains to be seen whether endoscopic techniques might be applicable to this surgery in the future.

In general, smaller incisions and exposure seem to be significantly aiding pediatric spine procedures. This is especially true because the bone healing in children is so robust that simply exposing additional levels or facets can lead to unwanted autofusion of the spinal column. Pediatric neurosurgeons often take advantage of this robust fusion in other ways by performing laminoplasty in place of laminectomy, as it is likely that the child's bone will fuse and reestablish normal anatomy.

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