Written informed consent was obtained from all patients or their guardians. All patients were placed under general anesthesia during surgery. No patient required a Foley catheter. Patients were placed prone on a Jackson table with a Wilson frame. A < 15-mm paramedian incision about 1 cm off the midline was made, and a tubular retractor system (most commonly METRx [Medtronic], but MARS3 V [Globus Medical] and Luxor [Stryker] were also used depending on availability) was docked against the medial facet and inferior lateral edge of the lamina at the level and side of the herniated disc. The position and angle of the tubular retractor system was confirmed with the use of intraoperative fluoroscopy. When the final 14or 18-mm-diameter tubular retractor was in place, an operative microscope was brought in, hemilaminotomy and medial facetectomy were performed, and the underlying ligamentum flavum was removed to expose the underlying impinged nerve root (Fig. 2). The herniated disc was identified, its annulus incised, and its nucleus pulposus resected. The wound was irrigated, and the fascial, deep dermal, and subcuticular layers were closed using absorbable sutures. No dural tears or changes in monitoring data were noted in any of the surgeries.
Metrx
Manufactured by Medtronic
Sourced in United States
The METRx is a minimally invasive surgical system designed for spinal procedures. It provides a platform for accessing and visualizing the surgical site through a small incision. The core function of the METRx is to facilitate minimally invasive spinal surgery, allowing for reduced tissue disruption and potentially faster patient recovery times.
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Lab products found in correlation
6 protocols using metrx
1
Minimally Invasive Lumbar Discectomy Technique
2
Minimally Invasive TLIF Surgical Protocol
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The MIS-TLIF was performed as previously described [20 (link)], and the MIS-TLIF surgery was performed from the symptomatic side of the patient. The surgical level was confirmed under C-arm guidance. A 3-cm incision was applied at lateral pedicle line on disc space, and a working channel was created with a tubular retractor (METRx, Medtronic, Memphis, TN, USA). Total facetectomy, partial laminectomy, and ligamentum flavum removal were performed using a high-speed drill, osteotome, Kerrison punch, and pituitary rongeur. Contralateral side decompression was performed in all patients, and discectomy and preparation of disc space for fusion were conducted. Autologous local bone was inserted in the empty disc space. Both 3D-printed titanium and PEEK cage were filled with a mixture of demineralized bone matrix and small autologous local bone, and the fusion material in both cages were the same except for the cage. During this process, we placed the cage at as much of a transverse angle as possible (Fig. 2 ). Finally, the percutaneous pedicle screw was inserted into the appropriate position under fluoroscopic guidance. All pedicle screws were the same (ZENIUS, Medyssey, Jecheon, Korea). All procedures were performed by one neurosurgeon, who had sufficient MIS-TLIF experience (more than 1,000 cases).
3
Minimally Invasive Spinal Decompression
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All procedures were performed in a single medical center by senior spinal surgeons who were well experienced in MIS surgeries. MIS decompression procedures were done routinely under general anesthesia using an 18 or 20 mm tubular retractor system (METRx; Medtronic Sofamor Danek, Memphis, TN, USA) and a surgical microscope. Surgery was performed using a unilateral approach, with either an ipsilateral or bilateral canal decompression while preserving the spinal midline structures, including the spinous process, supraspinous, and intra-spinous ligaments.
4
Minimally Invasive TLIF Techniques
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The inclusion criteria for this study were low-grade degenerative spondylolisthesis (grade 1), low-grade isthmic spondylolisthesis (grade 1), central stenosis with instabil-ity, and central stenosis with concomitant foraminal stenosis. Cases of infection, medical history of musculoskeletal disorders, multilevel spinal stenosis, spondylodiscitis, vertebral fractures, tumor, or high-grade spondylolisthesis were excluded. Minimally invasive TLIF was performed under microscopic or endoscopic view. Microscopic TLIF was performed using Caspar lumbar retractor or tubular retractor systems (METrx, Medtronic), while endoscopic decompressive procedures were performed using percutaneous biportal endoscopic systems (Arthrex, Stryker, and , EndoVision). Surgical approaches were chosen according to the spine surgeon's preference and experiences. Percutaneous biportal endoscopic TLIF was performed with ERAS while microscopic TLIF was performed without an ERAS pathway.
5
Minimally Invasive Transforaminal Lumbar Interbody Fusion
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During this procedure, a lateral skin incision was created on the symptomatic side. The muscle fascia was incised in line with the skin incision, and the muscle plane between the multifidus and longissimus muscles was identified with a gloved finger. Dilating instrument retractors (METRx; Medtronic, Minneapolis, MN, USA) were attached, and a decompression maneuver was completed. Inter-body fusion with cage was performed with harvested lamina and facet bone and demineralized bone matrix (Grafton; Medtronic, Minneapolis, MN, USA). For percutaneous pedicle screw fixation, a contralateral skin incision was made through the intermuscular plane, bilateral pedicle screws were placed on the corresponding level, and a rod was inserted percutaneously under fluoroscopic guidance (Longitude; Medtronic, Minneapolis, MN, USA) (Fig. 1 a).Figure 1 ![]()
MI TLIF approach (a) and conventional TLIF approach (b).
6
Minimally Invasive Spine Surgery for DLS
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For patients with DLS for whom medical management had failed, who elected to proceed with surgery, MIS decompression-alone procedures were offered to patients with neurogenic claudication, no or minimal mechanical back pain, anatomy favourable to a facet-sparing (i.e., undercutting) decompression, grade 1 (i.e., up to 25%) spondylolisthesis on radiographs, and no evidence of dynamic instability (an increase in 4–5 mm of spondylolisthesis demonstrated on flexion–extension or standing compared with supine radiographs). Decompression-alone procedures were performed from a unilateral approach with a tubular retractor (Tubular Retractor System, METRx, Medtronic) and involved a midline-sparing bilateral decompression. Patients not meeting the above criteria underwent MIS decompression and instrumented fusion procedures, which entailed a unilateral transforaminal interbody fusion (TLIF) using a cage and autologous bone graft, MIS decompression and percutaneous pedicle screw fixation.
Patients with hip OA for whom medical management failed and who decided to proceed with surgery underwent uncemented THA, performed from a lateral (Harding) approach. Cemented TKA using a medial para-patellar approach was performed for patients with knee OA for whom medical management failed and who elected to proceed with surgical management.
Patients with hip OA for whom medical management failed and who decided to proceed with surgery underwent uncemented THA, performed from a lateral (Harding) approach. Cemented TKA using a medial para-patellar approach was performed for patients with knee OA for whom medical management failed and who elected to proceed with surgical management.
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