This publication is not intended for distribution in. The plif spacer can be used for posterior lumbar interbody fusion plif. Original article clinical outcomes of posterior lumbar. Optimus, anterior lumbar fusion system sales sheet tech sheet. Direct lateral interbody fusion transpsoas approach dlif surgical technique instrument set 2 preoperative planning 7 nimeclipse spinal system needle electrode placement 8 patient positioning 10 localization 12 dissection to the psoas neuromonitoring through the psoas 14 dilation 16 retractor placement 16 disc preparation 19 trialing 23. Mas plif maximum access surgery the nuvasive maximum access surgery mas plif procedure is a minimally disruptive approach to traditional back surgery. Of the 42 patients, were allocated to the decompression group, and 53 to the plif group. Phenix, cervical interbody system sales sheet tech sheet surgical technique surgical technique animation instrument guide usage form fda clearance. Surgical technique in cases of decompression group, operations were carried out under general anaesthesia. The five primary interbody fusion approaches are shown here schematically. Notes this technique manual assumes that the surgeon is familiar with the techniques for performing a posterior lumbar interbody fusion plif, or transforaminal interbody lumbar fusion tlif. First, even when open technique is employed, careful attention to soft tissue handling can help improve posterior rmuscular function and may decrease pain. Lumbar fusion with the minimally invasive plif technique. Lumbar interbody fusion is a surgical technique that attempts to eliminate instability in the back.
The device system is designed for use with autograft to facilitate fusion. To learn basic surgical techniques surgical scrubbing gowning and gloving for surgery basic suturing techniques treatment of various wounds appropriate antibiotic use treatment of. The nerves of the lumbar plexus reside within the psoas, and the technique is dependent upon realtime electromyographic monitoring. Lumbar transforaminal lumbar interbody fusion tlif. Mobbs and others published l5s1 anterior lumbar interbody fusion technique find, read and cite all the research you need on researchgate. The alignment support frame on the shell inserter will not be vertical to the floor and should not be used as a positioning guide. The shurfit posterior lumbar interbody fusion system plif is indicated for intervertebral body fusion of the spine in skeletally mature patients. Advantages of the tlif procedure include shorter operative times, less. Lnk lumbar interbody fusion cage system surgicaltechnique. Surgical procedures appropriate for use with primalok sp include, but are not limited to.
Discectomy perform a complete discectomy on the desired disc using standard surgical instruments. Fluororadiography in true anteroposterior and lateral views are obtained at the operative level. When utilized bilaterally in a plif technique, it is important to remove the far lateral disc to allow for lateral placement along the lateral apophyseal ring. Posterior lumbar interbody fusion plif instruments. The surgeon who performs any implant procedure is responsible for determining and using the appropriate techniques for implanting the device in each patient. Minimally invasive techniques are widely used to reduce soft tissue damage. The remaining steps in this surgical technique are similar in open, less invasive and minimally invasive plif and tlif surgical procedures. Eit tlif cage surgical technique preparation and approach the patient is placed on the or table using the standard positioning in cases of transforaminal lumbar interbody fusion. Posterior lumbar interbody fusion in posterior lumbar interbody fusion plif, your surgeon inserts the spacer or cage from the back of the spine. There are several methods of treatment and posterior lumbar interbody fusion plif is one of them. The objective of this study is to compare the clinical and radiographic outcomes of dynesys and plif for lumbar degenerative disease. The higher morbidity and mortality rate reported with direct anterior surgery and higher implant failure with posterior fixation alone motivate us to search about.
Posterior lumbar interbody fusion plif spine surgery dr. Threaded cylindrical cages made of titanium, cortical allograft donor bone or synthetic bone. Pdf posterior lumbar interbody fusion for the management. The current main techniques of posterior lumbar interbody fusion plif surgery all incorporate a supplementary intervertebral implant. Clinical benefits xlif is the only lateral approach procedure proven by over 10 years of clinical evidence. Miniopen tlif through a modified wiltse paraspinal approach.
This technique was developed in conjunction with health care professionals. Minimally invasive posterior lumbar interbody fusion mis plif may be able to address these concerns, but the research on this topic has. With a good access surgical team, the complications associated with alif are minimal extreme lateral interbody fusion is a relatively new procedure. Posterior interbody procedures provide both posterior and anterior stabilization through a single incision. The surgical technique for medialized posterior interbody fusion mis plif. However, the tlif procedure places a single bone graft between. These techniques involve smaller incisions with use of retractors to dilatespread rather than cut muscles to gain access to the spine. Arthrodesis techniques are not free of complications, however, the frequency is lower. Satisfactory results after different surgical fusion techniques used in patients with low back pain has been shown in the literature to vary between 1695% 3fritzell et al. Posterior midline open the patient is positioned on the operating table in the prone position. Surgical technique 4 the following technique describes the unilateral insertion of a single implant into the disc space through a posterior lumbar interbody fusion plif approach, transforaminal lumbar interbody fusion tlif approach or anywhere in between based on the pathology being addressed and surgeon preference. Surgical technique determine the implant size with the help of the trial implants unilif trial, the implant size to be selected can be determined under xray control. Comparison of the dynesys dynamic stabilization system and.
Interbody fusions are categorised in achi by their surgical approach i. Impacted cages made of titanium, carbonfiber reinforced or plain peek polymer polyetheretheketone. Minimally invasive versus open posterior lumbar interbody. Thirdly, this article provides a description of each approach, and illustrates the potential benefits and disadvantages of each technique with reference to indication and spine level performed. Posterior fusion procedures posterior lumbar interbody fusion, plif. Posterior lumbar interbody fusion plif instruments technique guide synthes image intensi. Posterior lumbar interbody fusion plif demonstrated using contact fusion cage and clickx. Maximum access surgery mas posterior lumbar interbody fusion plif is a surgical procedure that was developed to provide spinal stability and help reduce pain in the lower back and lower extremities by using a less disruptive surgical procedure. Fusion surgeries typically require the use of bone graft to facilitate fusion. Before unlocking the trial, confirm by fluoroscopy that. Despite the positive findings reported by rampersaud, recent trends would suggest that surgeons are looking to further enhance outcomes by adding posterior lumbar interbody fusion plif or transforaminal lumbar interbody fusion tlif devices to the laminectomy and plf with instrumentation. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext.
Capstone peek spinal system plif and tlif surgical technique. Typically, screws and rods or other types of spinal instrumentation are used to hold the spine in position while the bone heals. Posterior lumbar interbody fusion plif technique was used to remove the bilateral laminae, facets and spinous ligament complexes of the lumbar spine. Posterior lumbar interbody fusion and transforaminal. A spine surgery frame should be used which will avoid any pressure on the abdomen. The surgical approach is carried out through a standard midline incision. Meeting the needs of advancing surgical techniques has required systems that are adaptable, reliable, and userfriendly. Aim the bridge towards the transverse process, feel. Alif, a number of technique tips apply in every interbody fusion procedure.
Robust connection a dedicated bladetoscrew connector gives the polyaxial screw monoaxial function, allowing for direct and effective distraction of the vertebral bodies. Posterior lumbar interbody fusion plif is generally used to treat back or leg pain caused by degenerative disc disease. The surgeon will stabilize the spine by fusing vertebrae together with bone graft material. Plif technique has been performed for several decades. Be sure that you are able to visualize the lateral portion of the superior facet. Specific application for minimally invasive plif insertion and wiltse tlif approach with tipeek interbody fusion technology. Make sure the abdomen is free positioned to avoid pressure on the large vessels and to minimize blood loss. Care should be taken to ensure the interbody spacer is aligned properly. Here, we report our novel technique of microendoscopeassisted posterior lumbar interbody fusion me plif using an 18mm tubular retractor system metrx, medtronic sofamor danek, memphis, tn, usa for lumbar spine degeneration treatment. As we all know, posterior lumbar interbody fusion plif is widely accepted and the most satisfying technique for managing degenerative lumbar spine diseases due to the advantages of restoring disc height, nerve root decompression, disc stabilisation, and reinforcement of the anterior spinal column since the first introduced in 1953 2. Distraction is essential to restore the disc height and decompress the neural elements. Spinal fusion is a technique used to stabilize the spinal bones or vertebrae. This involves taking small amounts of bone from the patients pelvic bone autograft, or from a donor allograft, and then packing.
A radiolucent or table is recommended, as xray shall be. The tplif instrument set supports the placement of tplif spacers used in transforaminal posterior lumbar interbody fusion tplif procedures. Transforaminal lumbar interbody fusion and posterior. Vaccaro and eli baron, offers a highly visual, stepbystep approach to the latest techniques in the field.
The distinct difference between a traditional open plif and a minimally disruptive maximum access surgery mas plif is the medialized surgical approach and smaller incision. 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. Most commonly it is performed on the l4l5 or l5s1 segment at the bottom of the lumbar spine. 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. To remove the implant, first fit the tips of the removal tool with the divots at the end of the implant figure 42. The patient positioned prone on a radiolucent operating table and prepped and draped in a conventional manner. The tplif approach is a unilateral alternative to the plif approach. The surgical options for interbody fusion of the lumbar spine include. It is not meant to replace any personal conversations that you might wish to have with your physician or other member of your healthcare team. Over 400 published clinical studies support the procedure, documenting positive clinical. There have been few studies comparing the clinical and radiographic outcomes between the dynesys dynamic stabilization system and posterior lumbar interbody fusion plif. Pdf l5s1 anterior lumbar interbody fusion technique. A definitive, richly illustrated text atlas with comprehensive coverage of positioning. Posterior lumbar interbody fusion surgery description.
In the plif technique, surgical access to the intervertebral disc is gained from a posterior direction. Posterior interbody fusion represents a spectrum of techniques. A lateral side approach is made safe with the use of nerve monitoring. A spine fusion is a surgical technique that connects two bones of spine together with new bone. Clinical outcomes of lumbar degenerative disc disease. Posterior lumbar interbody fusion plif cage removal.
Compared with posterolateral and lateral approaches, plif may be advantageous, providing a wider area of intervertebral interbody graft bone contact surface, improved load. Plif, alif and tlif procedures scoliosis and spine associates. Lumbar fusion with the minimally invasive plif technique preoperative information what is a lumbar fusion. Surgical technique preparing the aperture for the posterior approach retain as much as possible of the facets, as these stabilise the intervertebral segment. A lumbar fusion refers to fusing two or more vertebrae in the low back. Many spinal procedures can be done using minimally invasive techniques. It was an effective way of performing a fusion but the surgery caused a significant amount of discomfort and carried a higher risk of infection and complications. Surgical technique steps aleutian anatomicallynarrow lordotic interbody system 2 using a combination of surgical instruments osteotomes, kerrison rongeurs, antral punches, curettes, etc. First, the spine is approached through a threeinch to sixinch long incision in the midline of the back and the left and right lower back muscles erector spinae are stripped off the lamina on both sides and at multiple levels. Lumbar fusion with the minimally invasive plif technique pre.
Lateral access is a safe and reproducible means of addressing certain spine disorders with an approach from the side of the patient, as opposed to an approach from the back posterior or the front anterior. Hold back the dura mater to open an aperture of approx. To reduce these to a minimum, surgeons are required by the fda in the united states, and strongly recommended throughout the world, to attend an advanced instructional course on the oxford partial knee before attempting the operation. Microendoscopeassisted posterior lumbar interbody fusion.
A surgical approaches to the lumbar spine for interbody fusion techniques. Xlif the industry changing procedure continues to transform patients lives, transform surgical practices, and transform hospitals ability to provide superior, bestincare patient results. An atlas of surgery of the spine, howard s an, lee h riley iii, may 1, 1998, medical, 452 pages. An adaptation of the posterior lumbar interbody fusion plif technique first described by cloward, the t. Should it be necessary to remove or reposition the clydesdale spinal system device, the removal tool may be used. Over the past 10 years there has been a continuous evolution in the surgical application of pedicle screw fixation. Facet fixation system surgical technique guide 6 surgical approach with the facetgun max and a properlyloaded cassette, determine the proper trajectory over the desired facet joint. Older techniques for performing this type of fusion required that the muscles be cut from the back of the spine.
Khanna has an extensive training in minimally invasive spine surgery and strongly believes in the ability of mas plif to not only provide stability to spinal constructs, but significantly help patients by decreasing pain, recovery time, blood loss. Perform a laminectomy on the medial side of the facet with the osteotome or highspeed drill. Unilateral posterior approach using 28mm and 32 mm spacers figure 1 bilateral posterior approach using 24mm spacers 2efigr u. An introduction to this booklet is designed to inform you about the maximum access surgery mas posterior lumbar interbody fusion plif surgical procedure. During a plif posterior lumbar interbody fusion procedure, the damaged disc is removed from between two vertebrae in the lower back the lumbar region. Posterior lumbar interbody fusion plif is a surgical technique for placing bone graft between adjacent vertebrae interbody. According to surgical technique, 95 patients were divided into two groups. Like the plif posterior lumbar interbody fusion procedure, bone graft is used to fuse the spinal vertebrae after the disc is removed. Surgical technique surgical technique for posterior lumbar approach. With this approach, your surgeon gains access to your spine by removing the bone lamina and then retracting the nerve roots to one side. Major factors prompted the development of minimally invasive mis extreme lateral interbody fusion xlif. A transforaminal lumbar interbody fusion tlif is performed to remove a portion of a disc that is the source of back or leg pain.
Secondly, we propose a set of recommendations and guidelines for the indications for interbody fusion options. Surgical technique surgical technique animation fda clearance. Supplemental fixation for anterior lumbar interbody fusion alif, transforaminal lumbar interbody fusion tlif, lateral lumbar interbody fusion llif, posterior lumbar interbody fusion plif, posterior lateral fusion plf and. Are lumbar drains necessary after outpatient lumbar interbody. Miniopen transforaminal lumbar interbody fusion through a.
Posterior lumbar interbody fusion plif is a widely accepted surgical technique for the management of a variety of spinal conditions requiring spinal stabilization and fusion 15, 17, 19, 22. Surgical technique oblique posterior atraumatic lumbar cage system instruments and implants approved by the ao foundation. 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. Minimally invasive posterior lumbar interbody fusion plif. The ideal surgical treatment of spondylolisthesis still remains controversial. Pdf posterior lumbar interbody fusion plif with cages and local. Plif, alif and tlif procedures spinal fusion is a surgical procedure in which two or more vertebrae are joined or fused together. The tritanium pl cage system lends itself to minimally and less invasive techniques. All images in this technique guide depict an open procedure for image clarity.
These include providing interbody stabilization and indirect neural decompression while avoiding major visceralvessel injury as seen with anterior lumbar interbody fusion alif, and to avert trauma. Improved surgical techniques and improved interbody implants are among the reasons. Posterior lumbar interbody fusion plif spine surgery. This publication is not intended for distribution in the usa. Improved surgical techniques and improved interbody implants are among the reasons interest in these techniques is increasing.
Focusing solely on mustknow procedures, operative techniques. A posterior lumbar interbody fusion, called a plif, is a surgery designed to stop the motion at the targeted segment of the spine. The full text of this article is available in pdf format. The patient is initially positioned in a prone position on an andrews or jackson table. Various surgical options for lumbar interbody fusion have been reported. Spinal fusion may be recommended when the natural disc space has decreased or the spine is unstable. As surgeons become more proficient in the operation and as surgical technique is refined, sensory dysesthesias and psoas trauma associated with the procedure are becoming less prevalent. With the shell provisional in the appropriate alignment, use a. Medialized, musclesplitting approach for posterior lumbar. To connect the trial implant with the trial inserter plif inserter, the bar of the trial insertion instrument must be positioned in the groove of the trial implant. Miniopen oblique lumbar interbody fusion olif approach for multi. Tlif versus plif in spondylolisthesis maastricht university. Original article comparison of decompression only versus.
The goal of lumbar fusion is to create a solid bridge of bone between two or more vertebrae. With this approach, your surgeon gains access to your spine by removing the bone lamina and then retracting the. Distraction can be achieved using the lamina spreader or lateral distractor. Lumbar interbody fusion, as originally described by capener in the 1930s, used an anterior approach to the lumbar spine. Dlif surgical technique dlif surgical technique 25. A mas tlif achieves this by using a less invasive approach to fuse one or more vertebrae. Plif posterior lumbar interbody fusion plif is a surgical technique for placing bone graft between adjacent vertebrae interbody. Thorough updates keep you current with recent changes in spine surgery, and new contributors bring a fresh perspective to this rapidlychanging specialty. For a general clinical overview on the spine and spinal surgery, see. For a general clinical overview on the spine and spinal surgery, see ihpa. Intervertebral disc, retroperitoneal, spine surgery, psoas muscle, olif.