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Marc J. Levine, MD Rothman Institute Director Spine Surgery - - PowerPoint PPT Presentation
Marc J. Levine, MD Rothman Institute Director Spine Surgery - - PowerPoint PPT Presentation
Marc J. Levine, MD Rothman Institute Director Spine Surgery Program-Robert Wood Johnson University Hospital-Hamilton NONE SYMPTOMS MRI AXIAL 50% Low Back Pain 50% Right Leg Pain Neurogenic Claudication relieved sitting Failed
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SYMPTOMS MRI AXIAL
50% Low Back Pain 50% Right Leg Pain
Neurogenic Claudication –relieved sitting
Failed Non-operative treatment
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LATERAL RECESS STENOSIS FORAMINAL STENOSIS
Sagittal MRI Sagittal MRI
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BACK PAIN LEG PAIN
Facet Arthropathy Micromotion Degenerative Disc
Disease ANSWER FUSION
Lateral Recess Stenosis Facet arthropathy Ligamentous hypertrophy Foraminal Stenosis Collapsed disc height
Positional
- flexion better
- extension worse
DECOMPRESSION DIRECT/INDIRECT
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Percutaneous Wire Placement
Unilateral Screw Placement
Facectectomy
Lateral and Foraminal Decompression
Disc Space Preparation
Interbody Graft and Device Placement
Rod Placement
Contralateral Construct Completion
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Back Pain(facet/micromotion/- Fusion Leg Pain
- lateral recess (decompressed)
- foraminal (direct and indirect)
Neurogenic -positional
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Decrease hospital days
Decrease hospital cost
Decrease 2 year cost
Quicker RTW
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Less Blood Loss
Less Transfusions
Less Pain Med Requirements
Less Muscle Dissection
Clinical Benefits 1-2 years
Similar Long Term Benefits
LESS PHYSICIAN WEAR AND TEAR
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Identify exiting L4 nerve root
Identify traversing L5 nerve root
Beware of abnormal anatomy
Beware of nerve “shift” with spondylolisthesis
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Learning Curve Retractor Choices Endplate Preparation Interbody Choices
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Djurasovic M, Rouben DP, Glassman SD, Casnellie MT, Carreon LY1.Clinical Outcomes
- f Minimally Invasive Versus Open TLIF: A Propensity-Matched Cohort Study.Am J
Orthop (Belle Mead NJ). 2016 Mar-Apr;45(3):E77-82.
Terman SW, Yee TJ, Lau D, Khan AA, La Marca F, Park P.J Minimally invasive versus open transforaminal lumbar interbody fusion: comparison of clinical outcomes among obese patients.Neurosurg Spine. 2014 Jun; 20(6):644-52. Epub 2014 Apr 18.
Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR. Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta- analysis and systematic review.J Neurosurg Spine. 2016 Mar; 24(3):416-27. Epub 2015 Nov 13.
Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and
- utcomes.