Proven concepts and new solutions 10 fracture treatments. Please carefully read this surgical technique and its appendix prior to the use of the implant. It is designed to match vertebral anatomy and restore. The surgeon inserts bone graft material into thespace between the two vertebrae where the disc was removed the. The plif implants are bullet shaped blocks in wedged and parallel configurations of various heights 8mm 16mm, in 2mm increments, which are available in two footprints 22mm length x 10mm width, 26mm length x 10mm width. Posterior lumbar interbody fusion edison nj plif metuchen nj. Pedicle screws of the surgeons preference are inserted into the pedicles of the vertebrae adjacent to the disc space to be fused. Surgical technique this publication is not intended for distribution in the usa. The surgical options for interbody fusion of the lumbar spine include. However, when a posterior plif is combined with an alif or anteriorfrontal fusion, the success rates are off the charts. This fusion surgery is a refinement of the plif procedure and has recently gained popularity as a surgical treatment for conditions affecting the lumbar spine.
Please refer to the stryker retractor system surgical technique guides, including luxor, phantom, and. Full text transforaminal lumbar interbody fusion for lumbar. Posterior lumbar interbody fusion and transforaminal. The quantitative analysis of tissue injury markers after miniopen lumbar fusion. Pdf hybrid technique for posterior lumbar interbody fusion. The result of 465 cases of plif over a tenyear period showed 82% clinical satisfactory results and a 88% satisfactory fusion rate.
Capstone peek spinal system plif and tlif surgical technique. 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 insert and rotate technique can only be used for sizes 10 mm15 mm. Surgical technique helena posterior lumbar interbody fusion. Posterior lumbar interbody fusion technique the following technique describes a bilateral, open plif technique. Aside from delivering effective relief, you can expect to enjoy the following benefits. Methods such as transforaminal lumbar interbody fusion tlif, posterior lumbar interbody fusion, anterior lumbar interbody fusion and lateral lumbar interbody fusion are also available for interbody fusion in the literature.
Improved surgical techniques and improved interbody implants are among the reasons interest in these techniques is increasing. Posterior lumbar interbody fusion plif was described by jaslow 1 and was established and popularized by cloward. 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. Notes this technique manual assumes that the surgeon is familiar with the techniques for performing a posterior lumbar interbody fusion plif, or transforaminal interbody lumbar fusion tlif.
Lumbar transforaminal lumbar interbody fusion tlif. The key steps common to all the three procedures are. This manual is not intended to teach a surgeon how to perform a plif or tlif procedure. Expandable tlif and plif technology surgical technique. Numerous research studies in medical journals demonstrate greater than 9096% good or excellent results from plif and tlif surgery. The plivios revolution implants represent a further development of the plivios system. Minimally invasive surgical techniques may be employed to perform the procedure.
Perioperative complications associated with the surgical procedure, the implantation receives royalties on caliber globus medical. Our surgeons at the harley street hospital will make your spine stable by fusing vertebrae together with bone graft material. Surgical complications of posterior lumbar interbody. Lumbar fusion with the minimally invasive plif technique pre. The complement of minimally invasive percutaneous posterior lumbar interbody fusion mipplif 15 and minimally invasive surgery transforaminal lumbar interbody fusion mistlif 16 have made a. Tm ardis interbody system surgical technique zimmer biomet.
Posterior lumbar interbody fusion is a surgical procedure aimed to treat back or leg pain originated by degenerative disc disease. This approach reduces the amount of surgical muscle dissection and minimizes the nerve manipulation required to access the vertebrae, discs and nerves. The lumbar if cage for posterior lumbar interbody fusion with the. Minimally invasive percutaneous posterior lumbar interbody. Please see the nimeclipse spinal system package insert and users manual for. Pdf degenerative disc and facet joint disease of the lumbar spine is. Xlif is one relatively new technique that appears to accomplish this goal. A spine surgery frame should be used which will avoid any pressure on the abdomen.
Microendoscopeassisted posterior lumbar interbody fusion. Posterior lumbar interbody fusion plif instruments. Clinical benefits minimally disruptive, uncompromised surgical goals. Any surgical technique instruction manual should be carefully followed. In this procedure, thesurgeon works on the spine from the back the posterior and removes a spinal discin the lower lumbar spine. It was an effective way of performing a fusion but the surgery caused a significant amount of discomfort and carried a higher risk of infection and complications. The purpose of the present study was to examine rates of intraoperative and postoperative complications of plif using a large number of cases with uniform instrumentation and a uniform fusion. Midline lumbar fusion surgical technique mast midlf procedure midline lumbar fusion surgical technique 9 the starting point for a cortical screw is at the inferior aspect of the transverse process and about 3mm to 5mm medial to the lateral edge of the pars approximate midpoint of the inferior facet of the level above. Comparison between freehand and oarmbased navigated.
Plivios is designed for posterior lumbar interbody fusion plif. The advantage of this approach is that it requires less movement of the nerve roots. Plif, alif, tlif and xlif san diego spine foundation. Peek cage for posterior lumbar interbody fusion plif.
Minimal surgical steps, intuitive instrumentation, and a smooth leading implant edge allow for easy insertion, while the radiopaque nature of titanium permits placement in the desired location. Posterior lumbar interbody fusion with cortical bone. Previous studies of surgical complications associated with posterior lumbar interbody fusion plif are of limited value due to intrastudy variation in instrumentation and fusion techniques. All surgical techniques are available as pdf files. Plif technique, surgical access to the intervertebral disc. Posterior lumbar interbody fusion plif is a procedure used to treat problemssuch as disc degeneration, disc herniation, and spine instability. Cage size, shape, and position, in addition to surgical technique, determine lordosis during plif surgery. The surgical approach is carried out through a standard midline incision. This technique manual assumes that the surgeon is familiar with the techniques for performing a posterior lumbar interbody fusion plif, or transforaminal interbody lumbar fusion tlif. Furthermore, the surgical technique and their complications are described. An initial estimate of the cage size can be made by comparing the xray template with the adjacent intervertebral discs on a lateral radiograph. In transforaminal lumbar interbody fusion tlif, your surgeon approaches the disk space slightly more from the side. Surgical technique the surgical technique for saefc implantation is a simple, minimally invasive procedure, with only minor differences in technique between the plif, tlif, and acdf procedures. Posterior lumbar interbody fusion and transforaminal lumbar.
Older techniques for performing this type of fusion required that the muscles be cut from the back of the spine. Mas plif is an alternative solution to traditional continued. The plif implants are provided with and without lateral windows, and a crossbar feature is utilized to. This manual provides instruction in how to appropriately. Opal surgical technique depuy synthes 1 1 determine implant size option a. It is not intended to represent actual surgical technique or results. Spine depuy synthes pdf catalogs technical documentation. A maximum access surgery posterior lumbar interbody fusion mas plif achieves this by using a less disruptive. Adjustable leg holder with the standard operating table.
Mast midlf procedure midline lumbar fusion surgical technique. Surgical technique helena posterior lumbar interbody fusion p. This surgical technique guide will provide guidance. The system provides a full array of implant options featuring a bidirectional tapered leading edge, a large graft cavity and a streamlined instrumentation set to facilitate the insertion process.
Minimally invasive surgical techniques may be used to perform the procedure. The clinical and radiographical outcomes were compared between the two groups. Plif globus medical minimally invasive spine surgery. Various complications and pitfalls related to this procedure suggest that with meticulous technique and close adherence to the established protocol, plif can be performed safely with a high success rate of fusion. Plif technique has been performed for several decades. Proven concepts and new solutions 11 matrix spine system mis and. Full text transforaminal lumbar interbody fusion for. Surgical technique posterior lumbar interbody fusion plif page 2 of 5 preoperative planning preoperative planning is necessary for the correct selection of lumbar interbody fusion devices. Surgical technique hybrid technique for posterior lumbar interbody fusion. Surgical technique 1 preoperative planning prior to surgery, determine the appropriate cage height with the xray template. Advances in surgical techniques and materials have made this procedure minimally invasive for some patients. Posterior interbody procedures provide both posterior and anterior stabilization through a single incision. Posterior lumbar interbody fusion plif demonstrated using contact fusion cage and clickx. Instructions for use are in the surgical technique guide ml4 instructions for use, dualx tplif expandable transforaminal lumbar interbody fusion system 3 b.
Mas plif maximum access surgery mas posterior lumbar interbody fusion plif is a surgical procedure that was developed to provide spinal stability and help reduce pain in the lower back and lower extremities by using a less disruptive surgical procedure. Pdf hybrid technique for posterior lumbar interbody. The remaining steps in this surgical technique are similar in both open and minimally invasive surgical approaches. Pdf posterior lumbar interbody fusion plif with cages and local. This surgical technique is designed to familiarize healthcare professionals with the surgical procedure. Particular attention is given to indications, surgical technique, advan. Posterior midline open the patient is positioned on the operating table in the prone position. Pdf posterior lumbar interbody fusion via a unilateral. Single segment of posterior lumbar interbody fusion for adult.
Fullendoscopic posterior lumbar interbody fusion via an. Plif posterior lumbar interbody fusion plif is a surgical technique for placing bone graft between adjacent vertebrae interbody. Posterior lumbar interbody fusion plif spine surgery. Surgical technique for zavation ibf tlif, tplif and plif step 1 surgical approach to the disc posterior a midline incision provides exposure of the interlaminar space and facet joints at the indicated level. Based on the current literature, it is discussed which surgical techniques can be used in various cases.
From january 2006 to june 2008, 88 adult patients with isthmic spondylolisthesis who underwent surgical treatment in our unit were randomized to reduced group group 1, n 45 and in situ group group 2, n 43, and followed up for average 32. Plivios and plivios chronos technique guide depuysynthes 7 indications and contraindications plivios is designed for posterior lumbar interbody fusion plif. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Objective several biomechanical studies have demonstrated the favorable mechanical properties of the cortical bone trajectory cbt screw. Spine principle tplif technique feature clinical importance preservation of blood supply prepare endplates curettes facilitate a complete discectomy promotes bony fusion provide optimum large surface area for fusion bed placing bone graft around the implant creates an optimal environment for fusion early, pain free mobilization. The size on each trial corresponds to the full cage height including the teeth. Minimally invasive percutaneous posterior lumbar interbody fusion. Typically, screws and rods or other types of spinal instrumentation are used to hold the spine in position while the bone heals. Posterior lumbar interbody fusion is a technically challenging operation, whether open or mis, that has an important role in the modern management of lumbar spine pathology. The results of posterior lumbar interbody fusion plif and transforaminal lumbar interbody fusion tlif surgery in the treatment of symptomatic spondylolisthesis and degenerative disc disease are generally excellent. Impacted cages made of titanium, carbonfiber reinforced or plain peek polymer polyetheretheketone.
Posterior lumbar interbody fusion plif instruments technique guide synthes image intensi. Plivios revolution surgical technique depuy synthes 5 indications and contraindications intended use plivios is the synthes cage system for posterior lumbar interbody fusion plif. 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. A posterior lumbar interbody fusion plif is a surgical technique that involves correction of the spinal problems at the base of the spine by placing bone graft between two vertebrae. Posterior lumbar interbody fusion physical therapy in port. Comorbidities of the patient may make surgery more difficult.
However, no reports have examined surgical outcomes of posterior lumbar interbody fusion plif with cbt screw fixation for degenerative spondylolisthesis ds compared with those after plif using traditional pedicle screw ps fixation. A combination of open decompression and percutaneous pedicle screw fixation ralph j mobbs, md1,2,3, praveenan sivabalan, md2,3, jane li, md2,3, peter wilson, md1,2, prashanth j rao, md1,2,3 1. To present two minimally invasive surgical techniques using cortical bone trajectory screws with posterior lumbar interbody fusion cbtplif and traditional. In a traditional plif, a 36 inch incision is typically required depending on the number of surgical levels. Threaded cylindrical cages made of titanium, cortical allograft donor bone or synthetic bone. Cages and their corresponding trials come in 0, 5, and 10 lordotic options. The tlif technique involves approaching the spine in a similar manner as the plif approach but more from the side of the spinal canal through a midline incision in the patients back. Tlif surgical techniques has a long learning curve. Early, active pain free mobilization the fundamental aims of fracture treatment in the limbs. The patient is positioned on the operating table in the prone position. Recent trends in spinal surgery involve the use of interbody fusion techniques, including alif, posterior lumbar interbody fusion plif, transforaminal lumbar. Interbody implants are to be used with autogenous bone graft. Simultaneous lateral interbody fusion and posterior percutaneous.
Variety of sizes multiple tlif, oblique, plif lordotic, and plif convex sizes accommodate various patient anatomies and surgeon approach preferences. Since 2008 we have performed microendoscopeassisted posterior lumbar interbody fusion meplif using an 18mm tubular retractor. The implant must be seated firmly with a tight fit between the endplates when the segment is. As surgeons become more proficient in the operation and as surgical technique is refined, sensory dysesthesias and psoas trauma associated with the procedure are becoming less prevalent. Plif, alif and tlif procedures scoliosis and spine associates. Posterior interbody fusion represents a spectrum of techniques. A facetectomy andor laminotomy is performed using the surgeons preferred technique and instruments. The current main techniques of posterior lumbar interbody fusion plif surgery all incorporate a supplementary intervertebral implant. Guideline update for the performance of fusion procedures for. Dec 01, 2020 we have developed a newly interbody fusion technique of fullendoscopic posterior lumbar interbody fusion feplif via an interlaminar approach, with the combination of expandable cage technology and percutaneous screw fixation to achieve a 360degree stabilization of the lumbar spine. The technique includes all steps decompression, curettage of the endplate, bone grafting, and insertion of the cage, other than pedicle screw ps insertion, uses only a microendoscopic system, and has not been.
First, the surgeon makes an incision in the skin of the back over the vertebrae to be treated. Lumbar fusion surgery involving lateral lumbar interbody graft insertion with posterior. With a good access surgical team, the complications associated with alif are minimal extreme lateral interbody fusion is a relatively new procedure. All images in this technique guide depict an open tlif procedure for image clarity. Avenue t tlif cagesurgical technique guide 5 step 2 depending on the pathology, it may be necessary to partially or fully resect the facet joint andor the lamina. New trends in instrumentation and complex techniques in spine surgery. The posterior fusion procedures plif and tlif are presented and compared with other fusion methods, including advantages and disadvantages. The shurfit posterior lumbar interbody fusion system plif consists of implants with various widths, heights and lengths to accommodate individual patient. With freerunning emgs, the stimulated probe is used to trav. The lower limb is prepped and draped free below the tourniquet. Careful surgical technique that emphasizes wide exposure and avoidance of oversized implants can lead to excellent results with low complication rates and high fusion rates.
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