Arthroscopic techniques in minimally invasive spine surgery: Closure of the lumbar fascia: Surgical technique

BACKGROUND: The constrained working area in minimally invasive exposures of the spine may limit the capacity to effectively close the lumbar fascia, especially in patients with elevated body mass indexes. The working channel in these cases may have a diameter as narrow as 14 mm and a length up to 9 cm. Under these circumstances, the use of a conventional needle driver and a curved needle becomes suboptimal for closures of the fascia. OBJECTIVE: To demonstrate the utility of an arthroscopic suture passer for closure of the lumbar fascia in such approaches. METHODS: A flexible suture passer, typically used in arthroscopic rotator cuff repair surgery, was used through a minimally invasive portal for fascial closure after minimally invasive lumbar spine procedures. RESULTS: The use of an arthroscopic suture passer precludes the need for rotation of a curved needle in a constrained working area. Deploying a nitinol needle through an arc delivers the suture through the fascia, thereby facilitating closure. Satisfactory lumbar fascia closures were achieved in 18 patients with elevated body mass indexes. CONCLUSION: Application of existing technology in other surgical specialties may address the shortcomings of current techniques in minimally invasive approaches to the spine. The use of a flexible arthroscopic suture passer is one example in which current technology in one discipline may be applied to minimally invasive approaches. Increasing the awareness of techniques and instruments in other surgical disciplines may expand the armamentarium of the minimally invasive spine surgeon.