department of neurosurgery, mokpo hankook hospital, mokpo-city

Department of Neurosurgery, Mokpo Hankook Hospital, Mokpo-cityDepartment of Neurosurgery, Mokpo Hankook Hospital, Mokpo-city

1’st Evolution

Introductions

Historical Evolution of Post. Instrumentation

• 1970s, Luque; Luque Rods and Rectangles • 1960s, Dr. Paul R. Harrington; Harrington Rods and Hooks

Harrington Rods & Hook Luque Rods

Mokpo Hanook Hospital Hyeun Sung KimMokpo Hanook Hospital Hyeun Sung Kim

1’st Evolution

Introductions


Disadvantages • Instruments failure ---- rod breakage, hook dislocate, wire breakage • Insufficient stability • Insufficient correction • loss of correction • flat-back syndrome


2’nd Evolution

Introductions


• 1987, Cotrel & Dubousset; Pedicle screw, Rod and Hook TSRH Dynalock fixation system Simmons plating system Rogozinski system AMS reduction system Isola/VSP system Fixateur Interne Louis system Plumo-Winter-Byrd(PWB) system Edwards modular system 4CIS Solar spine system

CDCCDTSRHDynalock Fixation SystemSimmons Plating SystemRogozinski Spinal Rod SystemAMS Reduction Fixation SystemIsola/VSP SystemFixateur InterneLouis SystemPlumo-Winter-Byrd(PWB)SystemEdwards Modular System4CIS Solar


2’nd Evolution

Introductions


Disadvantages • large skin incision • extensive muscle dissection • trauma to the lumbar musculoligamentous complex • long operation time • significant blood loss • significant postoperative pain • postoperative paraspinal muscle denervation


3’rd Evolution

Introductions


Miniopen Decompression & Fusion • 1996, Leu HF & Houser RK; Perc. endoscopic lumbar spine fusion • 1998, Mathews HH; Percutaneous interbody fusions . . . • 2003, Foley KT; Minimally invasive lumbar fusion • 2006, Holly LT; TLIF: indications, technique and complications


Goals

Introductions

Miniopen Post. Decompression & Fusion

• minimal skin incision and anatomic dissection • minimal operation time • minimal blood loss & no transfusion • minimal postoperative pain • minimal hospital stay period • better cosmetic benefits


To reduce the approach-related morbidity associated with traditional lumbar fusionTo reduce the approach-related morbidity associated with traditional lumbar fusion

Types

Introductions


•Miniopen-PLIF •TLIF : midline incision : paramedian incision : stripping of m. origin : splitting of m. : interlaminar approach : transforaminal approach


Fixation methods

Introductions


• PPSF (Percutaneous Pedicle Screw Fixation) - using the Rod insertion system (Sextant, Apollon) - using the B-Twin ESS • PFSF (Percutaneous Facet Screw Fixation)


Applications

Introductions


•Spondylolisthesis grade I & II •Spinal stenosis •Instability •Fractures and Dislocations


Purpose

To

• introduce of surgical technique

• assess the safety, efficacy and results


• From Jan. 2004 to Jul. 2007 • 145 cases : Miniopen-posterior decompression and fusion • Follow-up period : 1 – 4 yrs • Age : 23 – 78 years old (M ; 64) • Sex : 89 (F) / 56 (M) • Level :

L4-5 (69 cases)L3-4 (26 cases)L5-S1 (23 cases)Thoracolumbar bursting fracture (13 cases)L3-4-5 (5 cases)L4-5-S1 (4 cases)L2-3 (4 cases)L2-3-4 (1 case)

Materials & Methods

Materials


1. Skin incision

Materials & Methods

Surgical Techniques


- midline in 3-6 cm

2. Dissection

Materials & Methods

Surgical Techniques


- stripping of origo-insertion of muscle- extend to facet joint

3. Decompression (interlaminar approach)

Materials & Methods

Surgical Techniques


- supra & interspinous lig., below half of spinous process & lamina

4. Disc preparation for fusion

Materials & Methods

Surgical Techniques


unilateral or bilateral

5. Insertion of bone chips & cages

Materials & Methods

Surgical Techniques


- anterior & both lateral area in disc space

6. Percutaneous pedicle screw fixation

Materials & Methods

Surgical Techniques


- using with Apollon rod insertion system

Cases


Case 1 : L4 Degnerative Spondylolisthesis grade I (M/65)

Preoperative X-ray Preoperative MRI

Postoperative 1st day Postoperative 1yrs

Cases


Case 2 : L4 Isthmic Spondylolisthesis Grade II without Osteoporosis(F/51)

Preoperative X-ray, MRI

Postoperative X-ray : 6months later Postoperative CT : 6months later

Cases


Case 3 : L4 Isthmic Spondylolisthesis Grade II with Osteoprosis (F/63)


Postoperative X-ray : 6 months later Postoperative CT : 6 months later

Cases


Case 4 : Unilateral Foraminal Stenosis with Instability : L4-5 (F/56)


Postoperative CT

Cases


Case 5 : Bilateral Foraminal Stenosis with Instability : L3-4-5 (F/60)

Preoperative X-ray Preoperative MRI : Rt. : Lt.

Postopertative X-ray Postopertative CT

Cases


Case 6 : T10 Bursting fracture (F/23) : Percutaneous Screw Fixation

Preoperative X-ray, CT, MRI

Postoperative X-ray, CT, MRI : 6 months later Postoperative Skin Scar

Cases


Case 7 : T12 Bursting fracture with Osteoporosis (F/58)

Postoperative X-ray, CT : 6 months later

Cases


Case 8 : T12 Pyogenic spondylitis(69/M)

Preoperative X-ray, MRI PostoperativeX-ray

• Mean op time• Pre & Post-op blood loss• Risk of blood transfusion• Post-op back pain (total narcotics use) • Duration of hospital stay• Post-op surgical scar• Clinical outcomes (by McNab’s criteria)• Radiological results• Complications

Results

Assessments for Results


Compare Miniopen-PLIF with Conventional PLIF

Results

Clinical Results

Miniopen-PLIF Conven- PLIF• Mean op time 135 mins (100-185) 150 mins(120-215)• Pre & Post-op blood loss 240 ml(160-390) 420 ml(300-580)• Risk of blood transfusion No 2 - 4 pints • Post-op back pain 4 days 7days (total narcotics use) • Duration of hospital stay 7 days (5-14) 12 days (7-21) • Post-op surgical scar Satisfactory Unsatisfatory• Clinical outcomes 95 % 93 % (Excellent & Good) (by McNab’s criteria)


Results

Radiological Results

• At last follow-up, all patients had solid fusions. • The period for fusion was not different between Mini-open PLIF and Conventional PLIF.


Results

Complications

• 2 cases of screw malposition (at the early learning period)


• is safe and efficacious method • has more advantages than the conventional PLIF 1. minimizing destruction to adjacent tissue

2. decreased blood loss & risk of transfusion3. decreased postoperative pain4. decreased total narcotics use5. decreased medical morbidity6. shorter hospital stay period7. better cosmetic

Conclusions

Miniopen-PLIF with PSF


department of neurosurgery, mokpo hankook hospital, mokpo-city

Documents

kim slide

mokpo hankook hospital

mokpocity slide

rod insertion system

invasive lumbar fusion

endoscopic lumbar spine

harrington harrington

luque luque rods