MIS Spine Surgery: Complications and Avoidance Lessons Learned - PowerPoint PPT Presentation

MIS Spine Surgery: Complications and Avoidance Lessons Learned

• Nuvasive • Orthofix • Medtronic • K2m

• • Retrospective study Cobb angle: • 25 patients (2-8 levels) – Preop 21.1 ° (10 – 48 ° ) Showed inadequately restored sagittal balance on 1/3 of • f/u mean 11 months (3-20) – Post op 6.4 ° (1 – 24 ° ). cases. • 2 stages • VAS: 5.7 impr. – Preop 8.1 • MIS techniques: – Post op 2.4 – Lateral (XLIF™ ) – Presacral (AxiaLIF™) • ODI impr 23.7% – Mini-open TLIF – Perc. pedicle screw • No pseudoarthrosis – Lat plate • Sagittal balance

ACR

Intradiscal vacuum Phenomenon

Stage Postop 1 st stage Preop

Fractional Curve

Fractional Curve

TLIF vs ALIF L5/S1

Facet Hypertrophy

Rotational component and curve magnitud

Rotational component and curve magnitud

In situ Bending

78 y/o F . LBP 90 % Intractable LBP , 10% LLE pain. VAS 8. Neurologically intact. PI: 56 PT: 29 LL: 31 SVA: 7 Coronal: 30 CSVL: 2

Strategies to Prevent/Manage Complications 1. Better understanding of ASD 2. High PI worst MIS enemy 3. Limitations of MIS techniques 4. Stage 5. Interspace vacuum air 6. Facet Hypertrophy 7. Rotational component 8. Fractional Curve 9. Importance of L5/S1 10. Anterior column manipulaiton 11. In situ bending 12. ALIF better than TLIF

• Significant challenges exist, as the surgical technique does not yet allow for all correction maneuvers used in open surgery. • MIS is not better than OPEN Techniques. IT IS DIFFERENT