Abd-El-Barr's Mountain-A Radiographic Landmark for Consistent and Successful Docking in Minimally Invasive Lumbar Surgery: A Cadaveric Study.

BACKGROUND: Minimally invasive surgical techniques have the potential to decrease the morbidity associated with traditional open surgery. However, surgeons may hesitate to implement minimally invasive techniques in their practice due to limited direct visualization and an arduous learning curve. Minimally invasive spine surgery requires precise docking of tubular or endoscopic retractors, which is difficult because without direct visualization of surrounding structures, surgeons may find themselves unable to orient themselves. Finding consistent and reproducible radiographic landmarks may decrease barriers to adoption of MISS techniques. Abd-El-Barr's point is a novel radiographic landmark that is identified on lateral fluoroscopy to help with docking for both tubular and endoscopic spine procedures. The landmark is hypothesized to correlate closely with the caudal aspect of the lamina and serve as a reliable docking target. OBJECTIVE: To validate Abd-El-Barr's point as a radiographic landmark for safe, reliable, and consistent docking in minimally invasive lumbar surgery. METHODS: A cadaveric study design: fluoroscopic localization of Abd-El-Barr's point was performed bilaterally from L1 to S1 using a sharply pointed instrument that was inserted slightly into the lamina to mark it with a hole, followed by dissection to measure the distance between the mark and the caudal lamina. RESULTS: A total of 5 cadaveric specimen data were analyzed. The mean distance from Abd-El-Barr's point to the caudal aspect of the lamina across all measured levels and sides was 5.3 mm (bilaterally). CONCLUSION: Abd-El-Barr's point is a reliable radiographic landmark that provides accurate and safe docking during minimally invasive lumbar decompression. Validated through anatomical dissection, it has the potential to standardize docking, provide efficient surgical workflow, and reduce variability across various surgeon experience levels. CLINICAL RELEVANCE: Using this landmark as a docking point, it is hoped that surgeons can make mininally invasive spine surgery, whether tubular or endoscopic, safer and more efficient, thus helping patients recover faster.

Duke Scholars

Author Peter George Kranz Radiology, Neuroradiology

Author Muhammad Abd-El-Barr Neurosurgery