A surgical approaches to the lumbar spine for interbody fusion techniques. Avenue t tlif cagesurgical technique guide 5 step 2 depending on the pathology, it may be necessary to partially or fully resect the facet joint andor the lamina. Posterior lumbar interbody fusion plif instruments technique guide synthes image intensi. With a good access surgical team, the complications associated with alif are minimal extreme lateral interbody fusion is a relatively new procedure. 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. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion.
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 plif is defined as posterior lumbar interbody fusion this approach requires a 46 incision in the center of the back to access one or two levels. Removal of the inferior a,b, su perior facet and ligamen tum flavum c,d and exposure of the nerve tissue and disc surface e. Conventional anterior lumbar interbody fusion alif and posteriortransforaminal lumbar interbody fusion pliftlif 4,5,6 techniques have given excellent. Unilateral minimally invasive posterior lumbar interbody. A transforaminal lumbar interbody fusion tlif is performed to remove a portion of a disc that is the source of back or leg pain. Surgical technique helena posterior lumbar interbody fusion. A prospective comparative study between classical posterior interbody fusion with peduncular screws and the new technique with divergent cortical screws was conducted. The aim of this study was to directly compare the clinical outcomes of posterior lumbar interbody fusion plif and minimally invasive transforaminal lumbar interbody fusion mistlif in threelevel lumbar spinal stenosis. The nerves of the lumbar plexus reside within the psoas, and the technique is dependent upon realtime electromyographic monitoring. They differ from anterior lumbar interbody fusion alif and extreme lateral interbody fusion xlif procedures by approach and associated complications. Posterior midline open the patient is positioned on the operating table in the prone position.
Typically, screws and rods or other types of spinal instrumentation are used to hold the spine in position while the bone heals. The plif procedure was first described in 1944 by briggs and milligan, who used laminectomy bone chips in the disc space as interbody graft. Lumbar transforaminal lumbar interbody fusion tlif. The tplif instrument set supports the placement of tplif spacers used in transforaminal posterior lumbar interbody fusion tplif procedures. Postoperative xrays and computed tomography ct studies documented that mis xlif with or without posterior instrumentation provided increased maximal disc removalend plate availability for interbody fusion while affording indirect decompression of the spinal canal degenerative stenosis or. 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. This procedure is used to promote fusion between the vertebrae. For years, lumbar interbody fusion has been used as a powerful surgical tool for various pathologies of the lumbar spine including degenerative disc disease ddd, spondylolisthesis, disc herniation, and deformity 1, 2. The posterior lumbar interbody fusion plif, in particular, encompasses the most desirable biomechanic features. Minimally invasive posterior lumbar interbody fusion plif. Unilateral minimally invasive posterior lumbar interbody fusion unilateral microplif for degen erative spondylolisthesis. A posterior lumbar interbody fusion, called a plif, is a surgery designed to stop the motion at the targeted segment of the spine.
The remaining steps in this surgical technique are similar in open, less invasive and minimally invasive plif and tlif surgical procedures. The concept of health status, indicated by qaly, represents individual responses to the physical, mental, and social effects of illness on daily living, while taking into account both the quantity and quality of life generated by health care interventions. Impacted cages made of titanium, carbonfiber reinforced or plain peek polymer polyetheretheketone. Pdf posterior lumbar interbody fusion for the management. Transforaminal lumbar interbody fusion tlif versus. Posterior fusion procedures posterior lumbar interbody fusion, plif. Like the plif posterior lumbar interbody fusion procedure, bone graft is used to fuse the spinal vertebrae after the disc is removed. The fluoroscope should have adequate access to the surgical field for both the lateral and anteroposterior views. This surgery may be done to treat lumbar degenerative disc disease, in. Shurfit posterior lumbar interbody fusion plif system overview 2 product highlights 2 indications 2 implant specifications 3 instrument specifications 5 surgical technique 6 1. A posterior lumbar interbody fusion plif is a lumbar fusion procedure from the back, or posterior approach. Surgical technique for zavation ibf tlif, tplif and plif step 1 surgical approach to the disc posterior a midline incision provides exposure of the interlaminar space and facet joints at the indicated level. Lumbar interbody fusion is a surgical technique that attempts to eliminate instability in the back. The five primary interbody fusion approaches are shown here schematically.
Plif posterior lumbar interbody fusion plif is a surgical technique for placing bone graft between adjacent vertebrae interbody. 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. Xlif surgical technique guide surgical tech classes. Posterior lumbar interbody fusion plif with instrumentation. Expandable tlif and plif technology surgical 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. Posterior lumbar interbody fusion overview youtube. Only patients with monosegmental degenerative disease were recruited into this study. A mas tlif achieves this by using a less invasive approach to fuse one or more vertebrae. Nvm5 was designed to enable a safer trajectory surgical technique. Posterior lumbar interbody fusion plif virginia spine. All images in this technique guide depict an open procedure for image clarity. Surgical technique patient positioning position on radiolucent table with adequate clearance for a.
Pedicle targeting obtain ap, lateral images of the affected level. Surgical technique hip knee spine navigation brochure m. Pedicle screws of the surgeons preference are inserted into the pedicles of the vertebrae adjacent to the disc space to be fused. 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.
Surgical technique lateral accesssurgical considerations xlif the xlif technique described in this guide utilizes a lateral, retroperitoneal, transpsoas approach to access the intervertebral disc. The t plif approach is a unilateral alternative to the plif approach. However, the tlif procedure places a single bone graft between. Effect of plif and tlif on sagittal spinopelvic balance of. Most commonly it is performed on the l4l5 or l5s1 segment at the bottom of the lumbar spine.
The t plif instrument set supports the placement of t plif spacers used in transforaminal posterior lumbar interbody fusion t plif procedures. The surgical approach is carried out through a standard midline incision. We analyzed a cohort of 40 patients treated from january 2015 to march 2016 divided into 2 groups 20. In transforaminal lumbar interbody fusion tlif, your surgeon approaches the disk space slightly more from the side. A facetectomy andor laminotomy is performed using the surgeons preferred technique and instruments. Frequently, pedicle screws are used for support due to nonunion development and increased instability in simple decompression methods. Pros of xrayct documentation of indirect decompression with extreme lateral interbody fusion. Posterior lumbar interbody fusion plif and transforaminal lumbar interbody fusion tlif are two different interbody fusion techniques, which promise better fusion rate than standard posterolateral fusion. The implant must be seated firmly with a tight fit between the endplates when the segment is. Surgical technique posterior lumbar interbody fusion plif page 2 of 5 preoperative planning preoperative planning is necessary for the correct selection of lumbar interbody fusion devices. Threaded cylindrical cages made of titanium, cortical allograft donor bone or synthetic bone.
A spine surgery frame should be used which will avoid any pressure on the abdomen. This retrospective study involved a total of 60 patients with threelevel degenerative lumbar spinal stenosis who underwent mistlif or plif from january 2010 to february 2012. All other hardware utilized for patient positioning should be checked for radiolucency. Transforaminal lumbar interbody fusion and posterior. It was not until 1953 when cloward described his technique, which used impacted blocks of iliac crest autograft that. During this procedure, your surgeon will make a midline incision in order to expose the posterior spine elements, such as the spinous process, lamina and facet joint. Distraction is essential to restore the disc height and decompress the neural elements. The quantitative analysis of tissue injury markers after miniopen lumbar fusion. Clinical benefits minimally disruptive, uncompromised surgical goals. In this study, we compared the clinical and radiologic outcomes of posterior lumbar interbody fusion plif and transforaminal lumbar interbody fusion tlif with pedicle screw fixation in the treatment of single. An adaptation of the posterior lumbar interbody fusion plif technique first described by cloward, the t.
Setup place the patient on a radiolucent operating table in the supine position. Posterior lumbar interbody fusion surgery globus medical. The current main techniques of posterior lumbar interbody fusion plif surgery all incorporate a supplementary intervertebral implant. The advantage of this approach is that it requires less movement of the nerve roots. 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. The size on each trial corresponds to the full cage height including the teeth. Posterior lumbar interbody fusion plif instruments.
Retrospective comparison of radiological and clinical. In 1946, jaslow modified the technique by positioning an excised portion of the spinous process within the intervertebral space. The tplif approach is a unilateral alternative to the plif approach. During a plif posterior lumbar interbody fusion procedure, the damaged disc is removed from between two vertebrae in. Posterior lumbar interbody fusion and transforaminal. The nerves of the lumbar plexus reside within the psoas, and the technique. Posterior lumbar interbody fusion techniques have been popular since the 1950. Mas plif is an alternative solution to traditional.
Posterior lumbar interbody fusion technique the following technique describes a bilateral, open plif technique. The tritanium pl cage system lends itself to minimally and less invasive techniques. Various surgical procedures have been recommended for the treatment of lumbar spondylolisthesis, but controversy still exists regarding the optimal surgical technique. Bone is removed to create a window to open the spinal canal.
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