An introduction to this booklet is designed to inform you about the maximum access surgery mas transforaminal lumbar interbody fusion tlif surgical procedure. These procedures can be performed as a plif, or posterior lumbar interbody fusion, through a paramedian annulotomy. A prospective comparative study between classical posterior interbody fusion with peduncular screws and the new technique with divergent cortical screws was conducted. Posterior lumbar interbody fusion plif instruments technique guide synthes image intensi. Comparison of posterior lumbar interbody fusion with. More studies with longer followup, including randomized trials, are necessary to evaluate the theoretical benefit of direct lumbar lateral approach and to assess whether the results of this strategy are superior and durable as the ones achieved by pliftlif technique performed in open or minimally invasive surgery. The remaining steps in this surgical technique are similar in open, less invasive and minimally invasive plif and tlif surgical procedures. Only patients with monosegmental degenerative disease were recruited into this study. Posterior midline open the patient is positioned on the operating table in the prone position. Medialized, musclesplitting approach for posterior lumbar. Posterior lumbar interbody fusion plif and transforaminal. Posterior lumbar interbody fusion techniques have been popular since the 1950. Like the plif posterior lumbar interbody fusion procedure, bone graft is used to fuse the spinal vertebrae after the disc is removed. The tplif instrument set supports the placement of tplif spacers used in transforaminal posterior lumbar interbody fusion tplif procedures.
However, the tlif procedure places a single bone graft between. The technique was designed to perform anterior lumbar interbody fusion or plif without the need for supplemental internal fixation. The tplif approach is a unilateral alternative to the plif approach. Surgical technique patient positioning position on radiolucent table with adequate clearance for a. Exposure and approach open or mis as described in the approach section figure 3 facetectomy. Avenue t tlif cage surgical technique guide zimmer biomet. The t plif instrument set supports the placement of t plif spacers used in transforaminal posterior lumbar interbody fusion t plif procedures. Minimally invasive transforaminal lumbar interbody fusion. This approach greatly reduces the amount of surgical muscle dissection and minimizes the nerve manipulation required to access the vertebrae, discs and nerves. Olifoblique lumbar interbody fusion linkedin slideshare. This technique, although associated with a relatively lengthy hospital stay, seems to be a viable alternative to combined anterior and posterior operations and posterior lumbar interbody fusion operations. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Transforaminal lumbar interbody fusion tlif in revision.
This surgery may be done to treat lumbar degenerative disc disease, in. The plif procedure was first described in 1944 by briggs and milligan, who used laminectomy bone chips in the disc space as interbody graft. The nerves of the lumbar plexus reside within the psoas, and the technique is dependent upon realtime electromyographic monitoring. During a plif posterior lumbar interbody fusion procedure, the damaged disc is removed from between two vertebrae in the lower back the lumbar region. A posterior lumbar interbody fusion plif is performed to remove a disc that is the source of back or leg pain and fuse spinal vertebrae with bone grafts. Plif posterior lumbar interbody fusion plif is a surgical technique for placing bone graft between adjacent vertebrae interbody. Posterior lumbar interbody fusion plif and posterolateral fusion plf are the most common approaches for treating a variety of degenerative lumbar spinal conditions. At the back table, assemble the plate assembly driver onto the ratcheting torque handle, and then assemble the plate to the peek spacer. This surgical technique guide will provide guidance. Medialized, musclesplitting approach for posterior lumbar i. Posterior lumbar interbody fusion overview duration.
The current main techniques of posterior lumbar interbody fusion plif surgery all incorporate a supplementary intervertebral implant. Mas plif maximum access surgery the nuvasive maximum access surgery mas plif procedure is a minimally disruptive approach to traditional back surgery. All images in this technique guide depict an open tlif procedure for image clarity. Manas panigrahi mch facs dr m b v prasad ms krishna institute of medical sciences, 2. Transforaminal and posterior lumbar interbody fusion tlif and. Transforaminal and posterior lumbar interbody fusion tlif. Distraction is essential to restore the disc height and decompress the neural elements. Minimally invasive anterior spinal interbody fusion oblique lumbar interbody fusion dr. When used for vertebral body replacement, the zyston straight spacer system is designed for use with. The existing evidence is mixed regarding the indications for and utility of ibf in dls, but its use in the setting of preoperative instability is most strongly supported. Historically, posterior lumbar interbody fusion was performed using a directly. Expandable tlif and plif technology surgical technique.
Posterior lumbar interbody fusion plif the plif technique is very similar to the tlif surgical procedure described above. Degenerative lumbar spine disease is one of the most rampantly prevalent healthcare problems in the world, with chronic low back pain being the second leading cause of adult disability in the united states. The quantitative analysis of tissue injury markers after miniopen lumbar fusion. The conventional open exposure used in plif has been associated with elevated rates of complications, most notably new postoperative radiculopathies or nerve injury and surgical site infections. Instructions for use are in the surgical technique guide ml4 instructions for use, dualx tplif expandable transforaminal lumbar interbody fusion system 3 b. Adonisplif cages are indicated for posterior lumbar vertebral body fusion. Preoperative planning and patient positioning are important to maximize the efficiency of the procedure. Most commonly it is performed on the l4l5 or l5s1 segment at the bottom of the lumbar spine. Adjacent segment disease after posterior lumbar interbody.
The purpose of this study was to describe the surgical. Posterior lumbar interbody fusion plif instruments. The surgical approach is carried out through a standard midline incision. Plif, alif and tlif procedures scoliosis and spine. Abdomen hangs free to decompress the vena cava and minimize venous engorgement. Threaded cylindrical cages made of titanium, cortical allograft donor bone or synthetic bone.
Posterior lumbar interbody fusion surgery description. A spine surgery frame should be used which will avoid any pressure on the abdomen. The plif technique is very similar to the tlif surgical procedure described above. No patient needed anterior approach p 0,000223 3,817e06 0,122777 0,367 0,00018 postop 28,9 53,5 1,8 53,0 2,9 preop 38,5 29,9 2,4 54,2 8,3. The primary goal of a posterior lumbar interbody fusion is to relieve pressure on either the nerve roots or spinal cord andor treat an unhealthy disc in the lumbar spine using a surgical approach through the back of the body. Spinal fusion is commonly used for treatment of degenerative disc disorders. The insert and rotate technique can only be used for sizes 10 mm15 mm.
Any surgical technique instruction manual should be carefully followed. Setup place the patient on a radiolucent operating table in the supine position. Mas plif is an alternative solution to traditional continued. An adaptation of the posterior lumbar interbody fusion plif technique first described by cloward, the t. Position patient the plif procedures have to be performed in natural lordosis, either in the prone position or in a relaxed kneechest position. The tritanium pl cage system lends itself to minimally and less invasive techniques. Posterior lumbar interbody fusion plif with instrumentation. The implants are designed to be perfectly adapted to the anatomy of vertebral bodies in order to reestablish lordosis for reliable normalisation of the alignment of the spinal column and to provide stability and optimum. Interbody fusion techniques in the surgical management of. Lumbar interbody fusion indications, techniques, and complications dr praveen k tripathi 27jan16 1 2. In a recent article, ray 7 presented a summary of a multicenter prospective food and drug administration investigative device exemption controlled study of 236 patients with disabling degenerative disc disease. Opal surgical technique depuy synthes 1 1 determine implant size option a.
Lumbar transforaminal lumbar interbody fusion tlif. The surgical options for interbody fusion of the lumbar spine include. Minimally invasive posterior lumbar interbody fusion plif. The remaining steps in this surgical technique are similar in both open and minimally invasive surgical approaches.
The tlif technique involves approaching the spine in a similar manner as the plif approach but more from the side of the spinal canal through a midline incision in the patients back. Instrumentation is used to provide space for placing the grafts and to help stabilize the. May, 2014 lumbar interbody fusion is a surgical technique that attempts to eliminate instability in the back. 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. Simultaneous lateral interbody fusion and posterior. Contact fusion cage surgical technique depuy synthes 5 qucheeti n l ac gi r us 1. Pdf posterior lumbar interbody fusion plif with cages and local.
Typically, screws and rods or other types of spinal instrumentation are used to hold the spine in position while the bone heals. Pdf posterior lumbar interbody fusion for the management. The popularity of the posterior lumbar interbody fusion plif procedure for spinal surgery has increased, with modifications such as autologous bone grafting, improved methods for spinal fusion, modern implants including a variety of cages and the use of pedicle screws for posterior instrumentation. Adjacent segment disease after posterior lumbar interbody fusion. Please refer to the stryker retractor system surgical technique guides, including luxor, phantom, and. The posterior lumbar interbody fusion plif, in particular, encompasses the most desirable biomechanic features. As with all surgical procedures, the technique used in each case will depend on the surgeons medical judgment as the best treatment for each patient. The system provides a full array of implant options featuring a bidirectional tapered leading edge, a large graft cavity and a streamlined instrumentation set to facilitate the insertion process. Mas plif is an alternative solution to traditional. Lumbar interbody fusion is a surgical technique that attempts to eliminate instability in the back.
This procedure is used to promote fusion between the vertebrae. 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. The following technique describes a bilateral, open plif technique. 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. Nerve decompression, plf, and simple decompression for symptomatic treatment are sufficient surgical methods. A transforaminal lumbar interbody fusion tlif is performed to remove a portion of a disc that is the source of back or leg pain.
Along with the technical advancements and improvements. The plif permitted a thorough decompression of the nervous structures without disrupting abdominal elements. Zyston straight spacer system is designed to restore the biomechanical integrity of the anterior, middle, and posterior spinal column even in the absence of fusion for a prolonged period of time. Implant assembly select the appropriate peek spacer footprint and height and the plate type zeroplate, halfplate or fullplate of the same height.
The bilateral plif technique with 2 cages was preferred by most surgeons. There is a wide variety of instrumentation and technique options. Capstone peek spinal system plif and tlif surgical technique. Lumbar interbody fusion indications techniques and. Retrospective comparison of radiological and clinical. A posterior lumbar interbody fusion, called a plif, is a surgery designed to stop the motion at the targeted segment of the spine. Miniopen transforaminal lumbar interbody fusion through a. Instrumentation, technique, and technology neurosurgery. The nerves of the lumbar plexus reside within the psoas, and the technique. The aim of this study was to compare the clinical efficacy between transforaminal lumbar interbody fusion tlif and posterior lumbar interbody fusion plif in treatment of lumbar spondylolisthesis. Minimally invasive transforaminal lumbar interbody fusion mi. Pedicle targeting obtain ap, lateral images of the affected level. Mas plif maximum access surgery spine surgeons, physical.
In 1946, jaslow modified the technique by positioning an excised portion of the spinous process within the intervertebral space. Miniopen tlif through a modified wiltse paraspinal approach can achieve satisfactory. 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 fluoroscope should have adequate access to the surgical field for both the lateral and anteroposterior views. Posterior lumbar interbody fusion surgery globus medical. Pdf transforaminal lumbar interbody fusion tlif versus. A maximum access surgery posterior lumbar interbody fusion mas plif achieves this by using a less disruptive. Several fusion techniques are available for lumbar arthrodesis. Posterior lumbar interbody fusion plif and transforaminal lumbar interbody fusion tlif.
All other hardware utilized for patient positioning should be checked for radiolucency. The t plif approach is a unilateral alternative to the plif approach. All images in this technique guide depict an open procedure for image clarity. Figure 2 l5s1 anterior lumbar interbody fusion technique and. The major difference is a more medial approach to the disc space with a potential of leaving both facet joints intact. Clinical benefits minimally disruptive, uncompromised surgical goals. Using an osteotome or drill, remove the ascending and descending articular processes. Mas plif 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. Impacted cages made of titanium, carbonfiber reinforced or plain peek polymer polyetheretheketone. We analyzed a cohort of 40 patients treated from january 2015 to march 2016 divided into 2 groups 20. Retrospective, multicenter study of perioperative results objective. Minimally invasive spine surgery miss has been popular in spinal fusion compared with conventional open technique because. No correction loss in frontal or sagittal plane except for one patient with deep infection.
It was not until 1953 when cloward described his technique, which used impacted blocks of iliac crest autograft that. It is called a posterior procedure because the spine is approached through an incision on the back. A mas tlif achieves this by using a less invasive approach to fuse one or more vertebrae. Pdf l5s1 anterior lumbar interbody fusion technique. We analyzed a cohort of 40 patients treated from january 2015 to march 2016 divided into 2. During a plif posterior lumbar interbody fusion procedure, the damaged disc is removed from between two vertebrae in. Sep 03, 20 more studies with longer followup, including randomized trials, are necessary to evaluate the theoretical benefit of direct lumbar lateral approach and to assess whether the results of this strategy are superior and durable as the ones achieved by plif tlif technique performed in open or minimally invasive surgery.
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