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An AOA Critical Issue: Less Invasive Procedures in Spine Surgery*
Edward Hanley, MD; Neil E. Green, MD; Dan M. Spengler, MD
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Edward Hanley, MD
Department of Orthopaedics, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203

Neil E. Green, MDDan M. Spengler, MDMedical Center North, D-4219 MCN, 1161 21st Avenue South, Nashville, TN 37232-2550

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

*This report is based on a symposium presented at the Combined Annual Meetings of the American Orthopaedic Association and the Canadian Orthopaedic Association, on June 3, 2002, in Victoria, British Columbia, Canada.

J Bone Joint Surg Am, 2003 May 01;85(5):956-961
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The financial pressures on the health-care system and the push to reduce hospital stays have provided a strong impetus toward minimally invasive procedures in all surgical specialties. These procedures frequently are associated with decreased perioperative morbidity, decreased duration of hospital stay, and reduced costs. Minimally invasive procedures are often popularized in the media or are advertised, and surgeons sometimes feel pressure to use new procedures to maintain a competitive practice. However, these types of procedures frequently require highly specialized equipment and training, and their outcome in the context of more traditional approaches needs to be carefully considered. Additionally, these procedures are often associated with unique and sometimes catastrophic complications. Lumbar microdiscectomy, video-assisted thoracoscopic surgery, and kyphoplasty represent relatively new minimally invasive techniques in spine surgery. We will discuss the current status of these procedures and the evidence supporting their increasing use in the management of spine patients. Patient selection remains a key to success for the newer minimally invasive techniques.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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