XLIF + ILIF ®circumferential arthrodesis as a minimally XLIF + ILIF ®circumferential arthrodesis as a minimally invasive fixation option: clinical results and imaging studyinvasive fixation option: clinical results and imaging study

Nicola Zullo M.D.Functional Unit of NeurosurgeryClinica Eporediese-Policlinico di

Monza IvreaSpine Surgery Division

Humanitas Gavazzeni BergamoChief: Corrado Musso M.D.

01.01.2013-07.01.2014: 22 + 46 circumferential procedures

XLIF+ILIF®: 11 cases out of 22 Nine out of 11 patients meet

the criteria of the present study, 8 patients were evaluated at least three months after surgery and were enrolled

VAS/ODI scores were collected pre and post operatively

Fusion rate was evaluated in 3 cases with lumbar CT scan

XLIF + ILIF® INDICATIONS single level discopaty with or without central/foraminal stenosis

(main treatment option) Single level discopaty with Grade 1 spondilolystesis

EXCLUTION CRITERIA Spondilolystesis > grade 1 Spinal deformity (scoliosis, sagittal

imbalance) Multilevel discopaty

SURGICAL TECHNIQUE

Standard XLIF® procedure Modified ILIF® (lateral or prone position) If necessary, microsurgical uni or bilateral

interlaminotomy /foraminotomy with spinous processes and articular sparing

ILIF ® modified technique: Usually interlaminar spacer Magnitude device not used Extensive removal of sopra and interspinous ligaments Careful decortication of spinous processes and laminar

boundaries Interspinous space filled with Bone allograft (Attrax® putty or

eterologous cancellous bone)

SURGICAL TECHNIQUE

FOLLOW UP

FOLLOW UP

POST-OP CT SCAN pz1

POST-OP CT SCAN pz2

POST-OP CT SCAN pz3

CONCLUSIONS XLIF® + ILIF® is a good, time sparing and minimally invasive fixation

option for single level discopaty/grade 1 spondilolystesis Overall clinical results are good; there’s no significant difference in

clinical outcome between XLIF + ILIF and other circumferential constructs.

Surgical time, total blood loss and hospitalization are shorter then those observed in XLIF® + percutaneous pedicle screws or open techniques.

Evidence of fusion on post-op CT scan in one patient with bone growth in intersomatic space behind Co-Roent cage; no evidence of fusion in interspinous and interlaminar space after at least three month after surgery.

No evidence of subsidence of the cages with ILIF as posterior fixation choice.