Michael Mayer

• MD,PhD
• Former Head of Department at Schön Klinik München Harlaching

Endoscopic spine surgeries have been vigorously developed. Now, endoscopic spine approaches are performed from cervical to lumbosacral area. Moreover, endoscopic lumbar interbody fusion surgeries have been attempted. New systems and instruments related with endoscopic spine surgeries are still developing. The indications for endoscopic spine surger...

Study design: Cross-sectional, international survey. Objectives: To identify factors influencing pharmacologic anticoagulation initiation after spine surgery based on the AOSpine Anticoagulation Global Survey. Methods: This survey was distributed to the international membership of AOSpine (n = 3805). A Likert-type scale described grade practic...

Study Design Cross-sectional, international survey. Objectives This study addressed the global perspectives concerning perioperative use of pharmacologic thromboprophylaxis during spine surgery along with its risks and benefits. Methods A questionnaire was designed and implemented by expert members in the AO Spine community. The survey was distri...

Study Design Nonrandomized prospective trial. Objective Several studies could demonstrate “learning curves” in almost every single surgical procedure for unexperienced surgeons. This is in sharp contrast to the rising quality requirements in public health care to provide surgical training at patients “expense.” The aim of this study was to visuali...

This book is a superbly illustrated guide to the latest endoscopic approaches employed in surgery to the lumbar spine. In the past, spinal endoscopic surgeries have been performed mainly in the treatment of lumbar disc herniation, but indications have now expanded owing to breakthroughs in surgical methods and instruments. Furthermore, in addition...

Study Design. Clinical and radiologic assessment obtained from an ongoing prospective trial following total lumbar disc replacement (TDR) with ProDisc II. Objective. To analyze the interaction between the parameters of disc space height (DSH), range of motion (ROM) and clinical outcome scores following TDR. Summary of Background Data. The interdepe...

Objective The main goal is bilateral microsurgical decompression of the cauda equina using a unilateral over the top approach. The challenge is to achieve decompression with minimal iatrogenic trauma to anatomical structures in the approach region and in the target area. Indications Degenerative spinal disorders including lumbar central stenosis,...

Purpose: To validate with a prospective study a decision-supporting coding system for the surgical approach for multi-level degenerative cervical myelopathy (mDCM). Methods: Ten cases were presented on an internet platform, including clinical and imaging data. A single approach (G1), a choice between two (G2), or three approaches (G3) were optio...

MINI: Cervical total disc replacement (with ProDisc Vivio) in patients with CSM yielded good clinical (NDI, VAS, JOA scores, Nurick grades) and radiographic outcomes and was found a reliable, safe and motion preserving surgical treatment option, although its indication is very limited due to numerous exclusion criterias. Study design: Non-randomi...

The new development and finally the general acceptance of surgical techniques among the worldwide surgical community sometimes create fascinating stories. This is also true for the history of endoscopic lumbar spine surgery. In the last 100 years there was a “natural” evolution of surgical techniques with continuous improvement and “refinement” of...

Purpose: Previous studies have demonstrated that total cervical disc replacement (cTDR) represents a viable treatment alternative to the 'gold standard' anterior cervical discectomy and fusion for the treatment of well-defined cervical pathologies at short- and mid-term follow-up (FU). However, the implementation and acceptance of a non-fusion phi...

Minimally invasive techniques are currently applied in large variety of spinal surgical procedures. Surgical invasiveness has been minimized mainly for surgical accesses but in some procedures (e.g. decompression surgery) also for the ‘target surgery’. Despite different techniques, there are general principles which have to be considered. Only with...

Study Design Cross-sectional and longitudinal validation study. Objective Development and validation of a short, reliable, and valid questionnaire for the assessment of low back pain–related disability. Methods The iDI was created in a stepwise procedure: (1) its development was based on the literature and theoretical consideration; (2) outcome d...

Introduction Back pain (BP) is a concern in youth and adult soccer players. Medical staff should be aware of possible consequences on health status and physical performance of players and, therefore, should screen and/or test for BP. Objective The purpose of the study was to assess female soccer players with and without BP in a range of tests. Meth...

Purpose To evaluate the lifetime prevalence of back pain (BP) in adolescent pupils depending on their activity level. Methods 372 Austrian pupils, 155 Bavarian soccer club members and 150 youth athletes who participated in summer camps of the Munich Soccer School 2013 took part in this cross-sectional retrospective cohort study. An iPad-compatible...

OBJECTIVE Herniated disc tissue removal to decompress the spinal nerve/cauda equina. Minimization of iatrogenic trauma and associated injuries. INDICATIONS Conservative treatment did not sufficiently improve clinical symptoms. This is true for progressive or persisting neurological deficits, as well as for persisting pain which alters the quality...

The purpose of this study is to identify several responsible parameters for back pain (BP) in youth soccer players to create a risk assessment tool for early prevention. An iPad-based survey was used to screen for parameters in a cross-sectional study. This questionnaire includes items regarding anthropometric data, training habits and sports injur...

Objective. Selective, bilateral multisegmental microsurgical decompression of lumbar spinal canal stenosis through separate, alternating cross-over approaches. Indications . Two-segmental and multisegmental degenerative central and lateral lumbar spinal stenosis. Contraindications . None. Surgical Technique. Minimally invasive, muscle, and facet jo...

Background During the last 20 years several less-invasive anterior approaches to the lumbar spine have become standard, including the extreme lateral transpsoas approach. Although it is associated with a lower risk of vascular injury compared with anterior midline approaches, neuromonitoring is considered mandatory to avoid neurologic complications...

Introduction Anterior lumbar fusion is a common treatment option for a variety of pathologies. In the last years minimally invasive anterior approach techniques are considered standard. One of them, the extreme lateral transpsoas approach (XLIF) has become popular in the last years. Within this XLIF-approach neuromonitoring is considered mandatory...

Introduction There is still a lack of facts about long term impacts after implantation of a total cervical disc replacement (cTDR). The aim of this current analysis was to evaluate the long- term clinical results and efficacy, the radiographic findings of the index level as well as the adjacent level in a cohort of cTDR patients treated with ProDis...

When I learned the first lesson in my “spine life,” the world of spinal surgery was black and white. For a given pathology, there were one or two treatment options. Today we are facing a wide variation of conservative and surgical treatment modalities. This makes the life of a spine surgeon easier and harder. It is easier to choose among different...

With the increasing numbers of lumbar disc surgeries, the quantity of revision cases is increasing as well. Especially recurrent disc herniations or discogenic restenosis of the spinal canal generate challenges in spinal microsurgery. Primary lumbar discectomy or fragmentectomy is performed with minimally invasive surgical techniques. Microsurgical...

Introduction Fusion of lumbar motion segments has been shown to be effective for the treatment of low back pain (LBP) from degenerative disc disease (DDD) in a cohort of patients that has been shown to be unresponsive to conservative treatment. However, previous fusion techniques performed via posterior approaches have been associated with a variet...

The present invention relates to an interspinous spacer (10, 10′, 10″, 10′″, 10″″, 10′″″) for implantation between adjacent spinous process (SP) to treat spinal stenosis. The interspinous spacer preferably includes a W-shaped or S-shaped leaf spring body member (21) for insertion between adjacent spinous processes and one or more wire straps (42) e...

Over the last decades, fusion of lumbar spinal motion segments has represented themainstay of treatment of lumbar degenerative conditions which failed to respond adequately to conservative therapy. Increasing demands and expectations from patients as well as the necessity to avoid fusion related negative side effects such as adjacent level disc deg...

Purpose The purpose of this study was to assess the mid-term clinical and radiological results as well as patient safety in terms of complication and reoperation rates in patients treated with a novel anterior stand-alone fusion (ASAF) device (Synfix-LR, DePuy Synthes, West Chester, PA, USA) in a cohort of patients with predominant and intractable...

The objective of this study was to investigate training profiles and motivation of male and female youth soccer players in different age groups and levels of play. A total of 1075 youth soccer players (U15-U19) from the Bavarian Football Association (BFV) in Germany completed a survey which investigated the total hours of training per week, and hou...

Introduction The role of fusion of lumbar motion segments for the treatment of intractable low back pain (LBP) from degenerative disc disease (DDD) remains controversially debated. Total lumbar disc replacement (TDR) has been used as an alternative in a highly selected patient cohort. However, the amount of long-term follow-up (FU) data on TDR is l...

Less invasive anterior approaches to the lumbar spine have been developed and become popular within the last 20 years. Although the influence of mid-term and long-term outcomes is yet unclear, they have significantly reduced peri-operative morbidity such as tissue trauma, blood loss, hospitalisation time and post-operative pain. This chapter descri...

This study addresses the epidemiology of injuries in adolescent male and female soccer players in Germany. Therefore, the purpose of the study was to analyse the injuries in male and female youth soccer players in Germany. This study was designed as a cross-sectional web-based survey. From March until December 2011 we investigated 1110 soccer playe...

Selective, bilateral multisegmental microsurgical decompression of lumbar spinal canal stenosis through separate, alternating cross-over approaches. Two- and multisegmental degenerative central and lateral lumbar spinal stenoses. None (however, if stabilization is necessary, the Slalom technique is not possible). Minimally invasive, muscle-sparing...

Background Aim of the study was analyze knee injuries in male and female youth soccer players.Materials and Methods With a web-based survey data of 1110 male and female players aged 12 to 19 years of all German youth leagues were collected.ResultsA total of 285 knee injuries in male and 83 knee injuries in female players occurred. The most common i...

Objective: Selective, bilateral multisegmental microsurgical decompression of lumbar spinal canal stenosis through separate, alternating cross-over approaches. Indications: Two- and multisegmental degenerative central and lateral lumbar spinal stenoses. Contraindications: None (however, if stabilization is necessary, the Slalom technique is no...

The role of fusion of lumbar motion segments for the treatment of axial low back pain (LBP) from lumbar degenerative disc disease (DDD) without any true deformities or instabilities remains controversially debated. In an attempt to avoid previously published and fusion-related negative side effects, motion preserving technologies such as total lumb...

Although histopathological grading systems for disc degeneration are frequently used in research, they are not yet integrated into daily care routine pathology of surgical samples. Therefore, data on histopathological changes in surgically excised disc material and their correlation to clinical parameters such as age, gender or body mass index (BMI...

Total lumbar disk replacement has become a routine procedure in many countries. However, discussions regarding its use are ongoing. Issues focus on patient selection, technical limitations, and avoidance or management of complications or long-term outcomes. A review of the development of this technology, since the development of the first successfu...

Surgical Goal Surgical treatment of dynamic lumbar spinal stenosis and discogenic/arthrogenic low back pain with a new percutaneous interspinous spacer as a therapeutic alternative to more invasive standard procedures. Indications Central, lateral and foraminal dynamic lumbar spinal stenosis. Discogenic and arthrogenic (facet osteoarthritis) low ba...

Objective: Minimally invasive anterior preparation of the lumbosacral junction L5/S1 via a retro- or transperitoneal approach, possibility of intervertebral mono- or bisegmental rigid (cage, bone graft) or dynamic (disc arthroplasty) segmental stabilization. Indications: Degenerative disc disease (DDD) with or without disc herniation. DDD with t...

Operationsziel Minimalinvasive ventrale Mittelliniendarstellung der Segmente L2–L5 über einen retroperitonealen oder transperitonealen Zugang. Indikationen Degenerative Bandscheibenerkrankung mit oder ohne Bandscheibenvorfall, welche die Indikation zur Implantation einer Bandscheibenprothese nach sich zieht. Prinzipiell auch degenerative Instabili...

Operationsziel Mono- oder bisegmentale operative Darstellung der ventralen Halswirbelsäule von C3–C7 zur Implantation künstlicher Bandscheiben über einen atraumatischen, mikrochirurgischen Zugang. Indikationen ‚Weiche‘ Bandscheibenvorfälle (Soft Discs) C3–C7 mit radikulärer Symptomatik. Ossifizierte, ‚harte‘ Bandscheibenvorwölbungen bei erhaltener...

Objective: Dynamic intervertebral support of the cervical spine via an anterolateral approach using a modular artificial disk prosthesis with end-plate fixation by central keel fixation. Indications: Cervical median or mediolateral disk herniations, symptomatic cervical disk disease (SCDD) with anterior osseous, ligamentous and/or discogenic nar...

Mono- or bisegmental atraumatic microsurgical approach to the anterior cervical spine between C3 and C7 for total disc replacement. 'Soft' disc herniations C3-C7 with radicular symptoms. Ossified 'hard' disc herniations with preserved segmental motion. Erosive osteochondrosis with signs of activation (MRI: Modic I changes) and neck pain. Relative I...

Dynamic intervertebral support of the cervical spine via an anterolateral approach using a modular artificial disk prosthesis with end-plate fixation by central keel fixation. Cervical median or mediolateral disk herniations, symptomatic cervical disk disease (SCDD) with anterior osseous, ligamentous and/or discogenic narrowing of the spinal canal....

SURGICAL GOAL: Surgical treatment of dynamic lumbar spinal stenosis and discogenic/arthrogenic low back pain with a new percutaneous interspinous spacer as a therapeutic alternative to more invasive standard procedures. Central, lateral and foraminal dynamic lumbar spinal stenosis. Discogenic and arthrogenic (facet osteoarthritis) low back pain. Sy...

Indirect decompression of the spinal canal and the neuroforamina by means of interspinous process distraction and limitation of extension movements. Reduction of forces acting on the posterior joint structures of a functional spinal unit (posterior anulus, facet joints, intervertebral discs). Primary indication: Spinal claudication with improvement...

To describe a minimally invasive midline approach, retroperitoneal or transperitoneal, to the lumbar spinal levels L2-L5. Degenerative disc disease (DDD) with or without disc herniation that may require a total lumbar disc replacement; also for fusion-cases like degenerative instability, tumors, isthmic and degenerative spondylolisthesis of all gra...

Minimally invasive anterior preparation of the lumbosacral junction L5/S1 via a retro- or transperitoneal approach, possibility of intervertebral mono- or bisegmental rigid (cage, bone graft) or dynamic (disc arthroplasty) segmental stabilization. Degenerative disc disease (DDD) with or without disc herniation. DDD with translatoric or frontal inst...

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Prospective clinical, x-ray, and magnetic resonance imaging investigation following total lumbar disc replacement (TDR) with ProDisc II (Synthes, Paoli, PA). To examine the progression of adjacent level degeneration (ALD), facet joint degeneration (FJD) as well as associated risk factors following TDR. Fusion procedures have been associated with ad...

Objective: The aims of laminoplasty are to expand the spinal canal, to secure spinal stability, and to preserve the protective function of the spine. Preservation of mobility is also a goal of this procedure for multiple-level involvement. Indications: Multisegmental spondylotic myelopathy with a relatively narrow spinal canal (anteroposterior s...

The aims of laminoplasty are to expand the spinal canal, to secure spinal stability, and to preserve the protective function of the spine. Preservation of mobility is also a goal of this procedure for multiple-level involvement. Multisegmental spondylotic myelopathy with a relatively narrow spinal canal (anteroposterior spinal canal diameter<13 mm)...

Objective Minimally invasive anterolateral retroperitoneal approach to the lumbar spinal levels L2–L5. Indications Anterior interbody fusion for the treatment of degenerative disk disease (DDD), degenerative instability, isthmic and degenerative spondylolisthesis, tumors, degenerative scoliosis, fractures, spondylodiscitis, failed back syndrome (ps...

Minimally invasive anterolateral retroperitoneal approach to the lumbar spinal levels L2-L5. Anterior interbody fusion for the treatment of degenerative disk disease (DDD), degenerative instability, isthmic and degenerative spondylolisthesis, tumors, degenerative scoliosis, fractures, spondylodiscitis, failed back syndrome (pseudarthrosis, post-dis...

Low back pain is a very common problem. Various treatments are available, but surgery has acquired increasing importance. In the United States, low back pain is now the principal reason for spinal surgery, and the number of procedures performed for this reason is similar to the number of total hip replacements. Consequently there is a need for care...

Prospective clinical study of total lumbar disc replacement (TDR) with ProDisc II (Synthes, Paoli, PA). To examine whether baseline variables VAS (Visual Analogue Scale) and ODI (Oswestry Disability Index) correspond with late and final postoperative outcome parameters and to identify early predictors of late outcome following total lumbar disc rep...

Clinical and radiologic assessment obtained from an ongoing prospective trial following total lumbar disc replacement (TDR) with ProDisc II. To analyze the interaction between the parameters of disc space height (DSH), range of motion (ROM) and clinical outcome scores following TDR. The interdependence between DSH, ROM and the clinical symptomatolo...

Standardized and validated self-administered outcome-instruments are broadly used in spinal surgery. Despite a plethora of articles on outcome research, no systematic evaluation is available on what actually comprises a good outcome in spinal surgery from the patients' and surgeons' perspective, respectively. However, this is a prerequisite for imp...

Although a variety of biomechanical laboratory investigations and radiological studies have highlighted the potential problems associated with total lumbar disc replacement (TDR), no previous study has performed a systematic clinical failure analysis. The aim of this study was to identify the post-operative pain sources, establish the incidence of...

Despite the increasing popularity of total lumbar disc replacement (TDR) in predominantly young and active patients, no previous study has addressed possibilities, limitations and potential risks regarding athletic performance following TDR. Mechanical concerns remain and the implant's resilience as regards its load-bearing capacity during sporting...

Prospective study analyzing midterm clinical results of total lumbar disc replacement (TDR) with ProDisc II performed at different lumbar motion segments. To assess the influence of the disc level and number of discs replaced following TDR on postoperative outcome. Multisegmental disc replacement procedures belong to the so-called "off-label" indic...

In performing a cross-sectional survey among spine patients from dii erent European regions, the present study attempted to identify domains determining a good outcome of surgery from a patients´perspectivepatients´perspective, and to explore possible regional dii erences. A structural interview was performed among 353 spine surgery patients to inv...

Total disc replacement is a challenge to every spine surgeon. It is a new technology with few mid- and long-term outcomes reported. It is a technique with excellent short-term outcomes at least in uncontrolled clinical trials. It tends to be superior to spinal fusion for selected indications. However, it is also a 'trendy' technique for uncritical...

Total disc arthroplasty offers both theoretical and practical advantages over fusion surgery as a treatment for low back pain. In the majority of cases, these relatively new devices owe much of their evolution to the success of other total joint replacements, in particular, hip and knee prostheses, which have been developed over the last four decad...

Prospective clinical study enrolled in 2 centers (Munich and Liberec) as part of a prospective European multicenter study with ProDisc C (Synthes Inc., Paoli, PA). The first goal of the study was to evaluate the rate of heterotopic ossifications identified with plain radiograph following total cervical disc replacement (TCDR). The second goal was t...

Prospective study analyzing midterm clinical results of total lumbar disc replacement (ProDisc II) for different indications. To assess functional outcome after total lumbar disc replacement (TDR) treated for varying indications. Despite its frequent use and increasing popularity, indications and contraindications for TDR have not been defined prec...

Introduction Spondylolytic spondylolisthesis is an osseous discontinuity of the vertebral arch that predominantly affects the fifth lumbar vertebra. Biomechanical factors are closely related to the condition. An immunohistochemical investigation of lysis-zone tissue obtained from patients with isthmic spondylolisthesis was performed to determine th...

Minimally invasive techniques are currently applied in large variety of spinal surgical procedures (Tables 1.3, 1.4). Surgical invasiveness has been minimized mainly for surgical accesses but not for target surgery. Despite different techniques there are general principles which have to be considered. Only with preoperative planning, the (education...

Microsurgical anterior lumbar interbody fusion (MINIALIF) L5/S1 describes a microsurgical modification of a transperitoneal surgical approach to L5/S1 through a “mini-laparotomy” in the midline.

Microsurgical decompression of the spinal canal is defined as a mono- or multisegmental, uni- or bilateral internal enlargement of the central and/or lateral volume of the spinal canal without performing a laminectomy. “Internal laminoplasty” is proposed as a synonymous term.

Anterior cervical discectomy and fusion is a reliable procedure with excellent clinical and radiological outcomes in 85-95% of the patients.[35,36] It is a procedure with a low peri - and postoperative complication rate.[5,6,7] Thus, these results will be hard to beat by any type of total disc replacement. The crucial points which will probably dec...

Spinal fusion is accepted worldwide as a therapeutic option for the treatment of degenerative disorders of the lumbar spine. Because there are only few evidence-based data available supporting the usefulness of lumbar spinal fusion, its questionable benefit as well as the potential for complications are the reasons for an ongoing discussion. In rec...

Spinal fusion is accepted worldwide as a therapeutic option for the treatment of degenerative disorders of the lumbar spine. Because there are only few evidence-based data available supporting the usefulness of lumbar spinal fusion, its questionable benefit as well as the potential for complications are the reasons for an ongoing discussion. In rec...

Marfan syndrome (MFS) is one of the most frequent connective tissue disorders, showing striking pleiotropism and clinical variability. There is autosomal dominant inheritance with complete penetrance but variable expression. Approximately 25% of MFS patients have no family history of the syndrome and represent sporadic cases due to new mutations. T...

In the early 20th century, surgical fusion of one or more ‘functional spinal units’ (FSU) was developed and primarily performed for the treatment of spinal infection.[1][1]–[4][2] In the second half of the century, the indication was broadened and soon included the treatment of deformities,

In Germany, lumbar disc herniations require surgical treatment in about 50,000 patients/year. The clinical and socio-economical results are determined by the preoperative duration of symptoms and preoperative time out of work (highly predictive). Other parameters such as severity of neurological deficits, morphology of disc herniation, age, associa...