Plif, alif and tlif procedures spinal fusion is a surgical procedure in which two or more vertebrae are joined or fused together. Transforaminal lumbar interbody fusion tlif in revision. 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. This technique describes an open surgical approach.
Spinal fusion, neurosurgical procedures, orthopedic surgical procedure, lordosis, combined. During a plif posterior lumbar interbody fusion procedure, the damaged disc is removed from between two vertebrae in. A comparison of posterior lumbar interbody fusion and. Degenerative deformity is a common and often missed cause of neurological compression. The paraspinal, posterolateral, or wiltse approach is an old technique that observes the principles of an mis procedure. However, the tlif procedure places a single bone graft between. Unlike the posterolateral gutter fusion, the plif achieves spinal fusion in the low back by inserting a cage made of either allograft bone or synthetic material peek or titanium directly into the disc space. The nerves of the lumbar plexus reside within the psoas, and the technique is dependent upon realtime electromyographic monitoring.
A spine fusion is a surgical technique that connects two bones of spine together with new bone. The plif procedure, popularized in the 1950s and 1960s by cloward, who. With this approach, your surgeon gains access to your spine by removing the bone lamina and then retracting the nerve roots to one side. A novel minimally invasive technique for lumbar decompression. Pertinent articles in reference lists were also inspected. Hlif is a minimally invasive technique for lumbar decompression, realignment and navigated interbody fusion with an emphasis on minimizing tissue trauma and postoperative pain. Pdf posterior lumbar interbody fusion plif with cages and local. Posterior lumbar interbody fusion plif instruments technique guide synthes image intensi.
Posterior lumbar interbody fusion plif with instrumentation. 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. 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. All images in this technique guide depict an open tlif procedure for image clarity. For more surgical technique information, please refer to the avs. Lumbar fusion with the minimally invasive plif technique preoperative information what is a lumbar fusion. Alif, a number of technique tips apply in every interbody fusion procedure. When the surgical approach for this type of procedure is from the back it is called a posterior lumbar interbody fusion plif. Capstone peek spinal system plif and tlif surgical technique. The mipplif technique was validated in three cadaveric torsos with six motion segments decompressed and fused. Plif surgical technique introduction 04 posterior interbody fusion with the stryker o. Lnk lumbar interbody fusion cage system surgicaltechnique. The principal indication for lumbar interbody fusion surgery is the. Development and clinical evaluation of bioactive implant for.
Royal oak ibfd system surgical technique transforaminal. First, even when open technique is employed, careful attention to soft tissue handling. Fusion surgeries typically require the use of bone graft to facilitate fusion. These procedures can be performed as a plif, or posterior lumbar interbody fusion, through a. The current main techniques of posterior lumbar interbody fusion plif surgery all incorporate a supplementary intervertebral implant. The higher morbidity and mortality rate reported with direct anterior surgery and higher implant failure with posterior fixation alone motivate us to search about. The incision is made over the spinous process of the level above the index disc level and extends to the spinous process of the level below figure 2. The surgical approach is carried out through a standard midline incision. This involves taking small amounts of bone from the patients pelvic bone autograft, or from a donor allograft, and then packing. Surgical procedures appropriate for use with primalok sp include, but are not limited to. Jan 20, 2015 extreme lateral lumbar interbody fusion surgical neurology sep 22, 2016. Future analyses with a larger cohort, long term followup, as well as a head to head comparison with other interbody arthrodesis techniques are needed. Tplif spacer instruments continued tplif rectangular curettes, 8 mm width left 389. A survey was conducted of literature published until june 20 using the medline and embase databases.
Plif, alif and tlif procedures scoliosis and spine associates. There have been few studies comparing the clinical and radiographic outcomes between the dynesys dynamic stabilization system and posterior lumbar interbody fusion plif. An adaptation of the posterior lumbar interbody fusion plif technique first described by cloward, the t. Transforaminal lumbar interbody fusion tlif in revision surgery for adult lumbar and thoracolumbar scoliosis i obeid, n aurouer, a bourghli. The techniques actually employed in each case will always depend upon the medical judgment of the surgeon before and during surgery as to the best mode of treatment for each patient. The innovasis px ha is one of the industrys first plif devices composed of invibios peekoptima ha enhanced. In the final analysis, the preferred treatment is that which addresses the needs of the specific patient. Minimally invasive versus open posterior lumbar interbody. The following general surgical technique guide is for illustrative purposes only. The objective of this study is to compare the clinical and radiographic outcomes of dynesys and plif for lumbar degenerative disease. Decompression and posterior lumbar interbody fusion plif with an interbody cage is widely used.
In posterior lumbar interbody fusion plif, your surgeon inserts the spacer or cage from the back of the spine. Surgical technique oblique posterior atraumatic lumbar cage system instruments and implants approved by the ao foundation. Minimally invasive versus open transforaminal lumbar. An introduction to xlif extreme lateral interbody fusion. Extreme lateral lumbar interbody fusion surgical neurology sep 22, 2016. Please reference the 510k or package insert for additional information and a complete. As with all surgical procedures, the technique used in each case will depend on the surgeons medical judgment as to the best treatment for each patient.
The nerves of the lumbar plexus reside within the psoas, and the technique. Lumbarsacral fusion by a combined approach using interbody. Lumbar transforaminal lumbar interbody fusion tlif a transforaminal lumbar interbody fusion tlif is performed to remove a portion of a disc that is the source of back or leg pain. Zeus l, lateral lumbar interbody system sales sheet sales sheet trident tech sheet surgical technique 3 blade surgical.
Plif, alif and tlif procedures scoliosis and spine. Any surgical technique instruction manual should be carefully followed. Posterior lumbar interbody fusion technique the following technique describes a bilateral, open plif technique. The tplif approach is a unilateral alternative to the plif approach. Zeus c, cervical interbody system sales sheet tech sheet surgical technique surgical technique animation instrument guide usage form fda clearance. Impacted cages made of titanium, carbonfiber reinforced or plain peek polymer polyetheretheketone. An introduction to xlif extreme lateral interbody fusion this booklet is designed to inform you about the extreme lateral interbody fusion xlif surgical procedure. The goal of lumbar fusion is to create a solid bridge of bone between two or more vertebrae.
First, even when open technique is employed, careful attention to soft tissue handling can help improve posterior rmuscular function and may decrease pain. Metaanalysis of clinical outcomes of lumbar fusion surgical. Pdf transforaminal lumbar interbody fusion tlif versus. A symmetric partial bilateral laminectomy of the cranial and caudal level is made to expose. The better way back spinetrack registry reach your height find a surgeon surgeons nuvasive is committed to continued. This technique describes an open tlif technique placing the acculif pl cage obliquely across the disc space. A transforaminal lumbar interbody fusion tlif is performed to remove a portion of a disc that is the source of back or leg pain. Cage 05 step 1 exposure 08 step 2 preparation of facet joints 08 step 3 unilif site preparation 09. 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. Historically, posterior lumbar interbody fusion was performed using a directly posterior procedure plif. The chief advantages of the tlif procedure compared with the plif. The principle indication for posterior lumbar interbody fusion plif surgery is in the stabilization and fusion of the spine following correction of adult spinal deformity. Lumbar fusion with the minimally invasive plif technique pre. The superficial layers of the entire cartilaginous endplates are removed to expose bleeding bone.
A lumbar fusion refers to fusing two or more vertebrae in the low back. Metaanalysis of clinical outcomes of lumbar fusion. Lumbar transforaminal lumbar interbody fusion tlif. Posterior lumbar interbody fusion plif instruments. Posterior midline open the patient is positioned on the operating table in the prone position. Lnk lumbar interbody fusion cage system surgicaltechnique 2 table of contents surgical technique introduction03. Please refer to the stryker retractor system surgical technique guides, including luxor, phantom, and. The remaining steps in this surgical technique are similar in both open and minimally invasive surgical approaches.
Lateral distraction to be used with pedicle screw fixation. Like the plif posterior lumbar interbody fusion procedure, bone graft is used to fuse the spinal vertebrae after the disc is removed. Threaded cylindrical cages made of titanium, cortical allograft donor bone or synthetic bone. Shawn odriscoll, md, phd mayo foundation, ken yamaguchi, md washington university, barnes jewish hospital graham king, md, msc university of western ontario 2 table of contents table. Minimally invasive percutaneous posterior lumbar interbody. Posterior interbody fusion represents a spectrum of techniques. Below are diagrams demonstrating the location of the xray markers as. All fields were screened using the key terms posterior lumbar interbody fusion or plif combined with transforaminal lumbar interbody fusion or tlif. Patients the better way back provides hope, support, and information to patients suffering from chronic back, leg, and neck pain. 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. Trials rcts, cohort and consecutive cases studies that compared at plif versus plf surgical interventions at the lumbar region. The patient positioned prone on a radiolucent operating table and prepped and draped in a conventional manner. Lumbar interbody fusion, as originally described by capener in the 1930s, used an anterior approach to the lumbar spine.
Resources nuvasive is dedicated to providing continued support and resources to patients and surgeons from preop to postop. Spinal fusion may be recommended when the natural disc space has decreased or the spine is unstable. The transforaminal lumbar interbody fusion tlif technique is a modification of posterior lumbar interbody fusion plif that allows a more lateralized, onesided, and direct access to the intervertebral foraminal area without violation of the anatomical integrity of the spinal neural elements. Lumbar fusion with the minimally invasive plif technique. Transforaminal lumbar interbody fusion tlif utilizes a more lateral window in order to access the interbody space without excessive dural retraction. The technique s actually employed in each case will always depend upon the medical judgment of the surgeon before and during surgery as to the best mode of treatment for each patient. A spine surgery frame should be used which will avoid any pressure on the abdomen. The aim of this study was to provide a stepbystep description from the literature of the wiltse paraspinal approach and analyze its main advantages and limitations.
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. Distraction is essential to restore the disc height and decompress the neural elements. Although anticipated pros of mis xlif included reduced blood. Distraction can be achieved using the lamina spreader or lateral distractor.
Cage 05 step 1 exposure 08 step 2 preparation of facet joints 08 step 3 unilif site preparation 09 step 4 distraction 09 step 5 discectomy and endplate preparation 11 step 6 sizing the disc space 12 step 7 o. Expandable tlif and plif technology surgical technique. 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. First, unlock the slope adjustment lock and then translate the tibial slope adjuster anteriorly until the desired angle is reached. The surgical approach that should be used for degenerative spondylolisthesis is a controversial issue. Mas plif maximum access surgery the nuvasive maximum access surgery mas plif procedure is a minimally disruptive approach to traditional back surgery.
Compared with posterolateral and lateral approaches, plif may be advantageous, providing a wider area of intervertebral interbody graft bone contact surface, improved loadsharing, adequate. This publication is not intended for distribution in the usa. Surgical technique guide 2 acknowledgments stryker spine wishes to thank the following surgeons for their dedication and contributions to the development of the acculif expandable lumbar interbody fusion technology. The surgical technique for medialized posterior interbody fusion mis plif. Adequate preparation of the endplates is important to facilitate vascular supply to the bone graft. Unilif surgical technique introduction 04 posterior interbody fusion with the stryker o. Comparison of the dynesys dynamic stabilization system and. The surgical technique shown is for illustrative purposes only.
In a plif procedure, implants are typically inserted bilaterally and parallel to each other. Posterior lumbar interbody fusion surgery description. Medialized, musclesplitting approach for posterior lumbar i. Spinal fusion is a technique used to stabilize the spinal bones or vertebrae. The data which extracted from the selected studies included. Royal oak ibfd system surgical technique transforaminal lumbar interbody fusion tlif. Posterior lumbar interbody fusion and transforaminal. During a plif posterior lumbar interbody fusion procedure, the damaged disc is removed from between two vertebrae in the lower back the lumbar region. Surgical technique animation instrument guide usage form fda clearance.
Fluororadiography in true anteroposterior and lateral views are obtained at the operative level. 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. How to perform the wiltse posterolateral spinal approach. Cage size, shape, and position, in addition to surgical technique, determine lordosis during plif surgery. Sigma primary knee system balanced surgical technique depuy synthes joint reconstruction 11 increase the angle of the tibial slope to greater than 0 degrees if the patient has a greater natural slope figure 15. The full text of this article is available in pdf format. Medialized, musclesplitting approach for posterior lumbar. Preoperative variables measured from imaging included interpedicular distance, pedicular height and width, interspinous distance, lordosis, intervertebral height, cobb angle, and foraminal height and volume.
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