The optimal treatment for degenerative lumbar diseases remains controversial 1, 2. Posterior lumbar interbody fusion plif is a surgical technique that attempts to eliminate instability in the back and pain in the lower back and lower extremities. However, the tlif procedure places a single bone graft between. This publication is not intended for distribution in the usa. Guideline update for the performance of fusion procedures for.
Posterior lumbar interbody fusion technique the following technique describes a bilateral, open plif technique. The goal of lumbar fusion is to create a solid bridge of bone between two or more vertebrae. Lumbar transforaminal lumbar interbody fusion tlif. Surgical technique implant selection the trigen intertan nail preoperative template set 71674200 may be used to assist with preoperative implant selection. An adaptation of the posterior lumbar interbody fusion plif technique first described by cloward, the t. Lumbar interbody fusion indications techniques and complications. A transforaminal lumbar interbody fusion tlif is performed to remove a portion of a disc that is the source of back or leg pain. The quantitative analysis of tissue injury markers after miniopen lumbar fusion. Expandable tlif and plif technology surgical technique. Spinal fusion may be recommended when the natural disc space has decreased or the spine is unstable.
The innovasis px ha is one of the industrys first plif devices composed of invibios peekoptima ha enhanced. Threaded cylindrical cages made of titanium, cortical allograft donor bone or synthetic bone. A compaction bone grafting technique leads to early bone fusion in cases of posterior lumbar interbody fusion. This involves taking small amounts of bone from the patients pelvic bone autograft, or from a donor allograft, and then packing. A facetectomy andor laminotomy is performed using the surgeons preferred technique and instruments. Minimally invasive versus open posterior lumbar interbody. Minimally invasive percutaneous posterior lumbar interbody fusion.
This technique may be applied bilaterally to any lumbar interbody space, based on the pathology being addressed and surgeon preference, and this technique may be performed through an open or minimally invasive approach. First, even when open technique is employed, careful attention to soft tissue handling can help improve posterior rmuscular function and may decrease pain. Apr 19, 2014 although conventional open posterior lumbar interbody fusion open plif is efficacious in management of lumbar spinal instability, concerns exist regarding lengthy hospital stays, blood loss, and postoperative complications. When the surgical approach for this type of procedure is from the back it is called a posterior lumbar interbody fusion plif. Reimbursement questions nuvasive reimbursement guide the nuvasive reimbursement guide contains current spine arthrodesis procedure codes and descriptions, medicare drg and apc payment values, relevant.
Future analyses with a larger cohort, long term followup, as well as a head to head comparison with other interbody arthrodesis techniques are needed. Compaction bone grafting technique leads to early bone fusion. Shawn odriscoll, md, phd mayo foundation, ken yamaguchi, md washington university, barnes jewish hospital graham king, md, msc university of western ontario 2 table of contents table. Cages and their corresponding trials come in 0, 5, and 10 lordotic options. However, no reports have examined surgical outcomes of posterior lumbar interbody fusion plif with cbt screw fixation for degenerative spondylolisthesis ds compared with those after plif using traditional pedicle screw ps fixation. Unlike the posterolateral gutter fusion, the plif achieves spinal fusion in the low back by inserting a cage made of either allograft bone or synthetic material peek or titanium directly into the disc space. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Plif, alif and tlif procedures spinal fusion is a surgical procedure in which two or more vertebrae are joined or fused together.
A pocket manual provides the gold standard in correlating clear, practical anatomy with the correct technique in the pursuit of the best possible patient outcomes. Ebook operative techniques in spine surgery as pdf download. Transforaminal lumbar interbody fusion tlif in revision surgery for adult lumbar and thoracolumbar scoliosis i obeid, n aurouer, a bourghli. Impacted cages made of titanium, carbonfiber reinforced or plain peek polymer polyetheretheketone. The plif spacer can be used for posterior lumbar interbody fusion plif. The current main techniques of posterior lumbar interbody fusion plif surgery all incorporate a supplementary intervertebral implant. Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. Note as template magnification levels are set at 117%, all measurements are estimates of true size. During a plif posterior lumbar interbody fusion procedure, the damaged disc is removed from between two vertebrae in the lower back the lumbar region. Alif, a number of technique tips apply in every interbody fusion procedure.
Preoperative variables measured from imaging included interpedicular distance, pedicular height and width, interspinous distance, lordosis, intervertebral height, cobb angle, and foraminal height and volume. Suture technique and closure instrumentation the latitude surgical technique has been developed in conjunction with. Several biomechanical studies have demonstrated the favorable mechanical properties of the cortical bone trajectory cbt screw. The mip plif technique was validated in three cadaveric torsos with six motion segments decompressed and fused. The size on each trial corresponds to the full cage height including the teeth. Spinal fusion is a technique used to stabilize the spinal bones or vertebrae. A maximum access surgery posterior lumbar interbody fusion mas plif achieves this by using a less disruptive approach to decompress nerve roots and fuse one or more vertebrae. The currently recommended surgical procedures are the anterior lumbar interbody fusion, the posterior lumbar interbody fusion plif, and the transforaminal lumbar interbody fusion tlif 37. A crosssectional, observational study of preoperative radiographs, in which measures of spinal sagittal alignment were acquired from the preoperative radiographs of 382 consecutive patients with spondylolisthesis isthmic85 and degenerative297 using the pelvic radius technique reference. Lnk lumbar interbody fusion cage system surgicaltechnique. This fourth edition of surgical anatomy and technique. As with all surgical procedures, the technique used in each case will depend on the surgeons medical judgment as to the best treatment for each patient. Plif, alif and tlif procedures scoliosis and spine associates. A comparison of posterior lumbar interbody fusion and.
Fusion surgeries typically require the use of bone graft to facilitate fusion. The following general surgical technique guide is for illustrative purposes only. Handbook of spine surgery pdf spine surgery, surgery. Nail size, screw length and femoral neck angle may be determined. The periloc vlp variableangle locked plating system combines the benefits of both. Adequate preparation of the endplates is important to facilitate vascular supply to the bone graft. Extreme lateral interbody fusion xlif is a relatively new technique whereby access to the disc space is achieved through a minimally invasive lateral, retroperitoneal, transpsoas approach. Feb 11, 2016 lumbar interbody fusion indications, techniques, and complications dr praveen k tripathi 27jan16 1 2. Introduce the plif spreader connected to a quick release. A novel minimally invasive technique for lumbar decompression. Posterior lumbar interbody fusion with cortical bone. Transforaminal lumbar interbody fusion and posterior lumbar. Mas plif maximum access surgery the nuvasive maximum access surgery mas plif procedure is a minimally disruptive approach to traditional back surgery.
Minimally invasive versus open transforaminal lumbar. Transforaminal lumbar interbody fusion and posterior lumbar interbody fusion utilizing bmp2 in treatment of degenerative spondylolisthesis. They found that fusion rates were higher and instrumentationrelated complication rates were. Operative techniques in spine surgery top results of your surfing operative techniques in spine surgery start download portable document format pdf and ebooks electronic books free online rating news 20162017 is books that can provide inspiration, insight, knowledge to the reader. Surgical technique oblique posterior atraumatic lumbar cage system instruments and implants approved by the ao foundation. Hlif is a minimally invasive technique for lumbar decompression, realignment and navigated interbody fusion with an emphasis on minimizing tissue trauma and postoperative pain. Reimbursement nuvasive is dedicated to offering resources for healthcare professionals seeking a better understanding of coding, coverage, and payment related to our technologies and therapies. Differentiating surgical instruments top results of your surfing differentiating surgical instruments start download portable document format pdf and ebooks electronic books free online rating news 20162017 is books that can provide inspiration, insight, knowledge to the reader. Cheng and colleagues 9 performed a randomized trial to evaluate the differences between plf and posterior lumbar interbody fusion plif following decompression in a group of 8 patients with degenerative or isthmic spondylolisthesis grade i or ii. Introduction spinal fusion the ultimate goal of a fusion is the elimination of pathologic segmental motion and its accompanying symptoms achieved by the formation of osseous bridging across the previously mobile level.
The superficial layers of the entire cartilaginous endplates are removed to expose bleeding bone. All the existing chapters have been updated and expanded to reflect current surgical approaches and instrumentation. Transforaminal lumbar interbody fusion tlif in revision. Like the plif posterior lumbar interbody fusion procedure, bone graft is used to fuse the spinal vertebrae after the disc is removed. The transforaminal lumbar interbody fusion tlif technique is a modification of posterior lumbar interbody fusion plif that allows a more lateralized, onesided, and direct access to the intervertebral foraminal area without violation of the anatomical integrity of the spinal neural elements. Royal oak ibfd system surgical technique transforaminal. Avenue t tlif cage surgical technique guide 5 step 2 depending on the pathology, it may be necessary to partially or fully resect the facet joint andor the lamina.
Ebook differentiating surgical instruments as pdf download. Posterior lumbar interbody fusion plif instruments. This procedure can be performed at any level in the spine cervical, thoracic, or lumbar and prevents any movement between the fused vertebrae. The nerves of the lumbar plexus reside within the psoas, and the technique is dependent upon realtime electromyographic monitoring.1470 917 86 31 1436 18 1105 1019 229 774 773 1179 158 687 56 995 838 909 831 1096 404 1441 1347 800 658 568 865 157 1110 292 861 1427 519 622 1363 253 761 20 94 322 983 923 728 1413 72 341 1215 93