![Page 1: INTRO. TO SPINAL SURGERIES · 2016. 3. 30. · listhesis 2f : 1 m cause l5-s1 most common 2m : 1f cause l5-s1 6f : 1m age >40 10%f>60 cause. tlif: remove the inferior facet 52 ca#](https://reader035.vdocument.in/reader035/viewer/2022071604/613f86dff0f55d448e4cda2d/html5/thumbnails/1.jpg)
INTRO. TO SPINAL SURGERIES
WAYNE CHENG, MD
BONES AND SPINE
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OUTLINE
• Decompression
• Spinal stenosis
• Herniated disc
• Fusion
• Deformity
• Fractures
• Degeneration
• Dynamic Stabilization/Motion preserv.
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HERNIATED DISC
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HERNIATED DISKCLINICAL PRESENTATION
• Young patients
• Radiculopathy (sciatic pain)
• L4, L5,S1
• Leg pain more than back pain
• Increase with cough or straining
• Positive straight leg raise
• More pain with flexion than extension
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HERNIATED DISC
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MRI-HNP
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MICRODISCECTOMY
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MICRODECOMPRESSION
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OUT-PT SURGERY; POST-OP SCAR
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SPINAL STENOSIS
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MICRO DECOMPRESSIONFACET CYST REMOVAL
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TREAT PATIENT NOT X-RAY !
• 67Asymptomatic
volunteers:
• MRI + Herniated disc
• <60 yo = 20%
• >60 yo = 36%
• >80 yo = 90%
(Boden JBJS 1990)
• 98 Asymptomatic vol.
• 36% had normal disc at all
levels
(Jensen NEJM 1994)
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FUSION IS FOR INSTABILITY/DEFORMITY
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INSTABILITY-SCOLIOSIS
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INSTABILITY - KYPHOSCOLIOSIS
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INSTABILITY - HYPERLORDOSIS
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INSTABILITY – CHIN ON CHEST
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INSTABILITY - FRACTURES
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INSTABILITY –DEGENERATIVE SPONDYLOLISTHESIS
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SCOLIOSIS – 10 TO 13 YO
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SCOLIOSIS
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KYPHOSIS
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POSTERIOR COLUMN OSTEOTOMYSMITH-PETERSEN
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POSTERIOR APPROACH -FUSION DISEASE?
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Left ureter
Left common iliac vein
L5-S1 Exposure
Right CIADisc Space
ANTERIOR APPROACH
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ANTERIOR & POSTERIOR APPROACH
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TRANSPSOAS APPROACH
• XLIF = DLIF=OLIF=LIF
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POSITIONING
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POSITIONING
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FLUORO POSITIONING• Cannot overemphasize the importance of good
fluoroscopic images
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APPROACH
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PLACEMENT
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RETRACTOR
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RETRACTOR
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DISC PREPARATION
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IMPLANT
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67 YO FEMALE W BACK PAIN, AND NEUROGENIC CLAUDICATION
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PRE OP MRI
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INTRA-OP
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INTRA OP
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INSTABILITY – FRACTURE ( 31 YO)
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PERC. NEEDLES
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MIN INVASIVE FUSION
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PERC. SCREWS
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PERC. INSTRUMENTATION
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SPONDYLOLISTHESISWILTSE,NEWMAN,MCNAB 1976
dysplastic isthmic degenerative
traumaticpathologic
20%
listhesis
2F : 1 M
Cause
L5-S1
Most common
2M : 1F
Cause
L5-S16F : 1M
Age >40
10%F>60
cause
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TLIF: REMOVE THE INFERIOR FACET
52 CA# 9914A
DJ# 11272A
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TLIF: REMOVE THE SUPERIOR FACET
53 CA# 9914A
DJ# 11272A
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STEP 18: INSERT IMPLANT
54 CA# 9914A
DJ# 11272A
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TLIF
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DILATION/DECOMPRESSION
56CA# 9914A
DJ# 11272A
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CURRENT MIS TLIF/PLIF2 BILATERAL WILTSE
CA# 9914A 57
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47 YO F, 250#, BACK AND L. LEG PAIN
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MIS TLIF- PERC. SCREWS
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DILATOR PLACEMENT
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CAGE PLACEMENT
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CASE 265 yo with lower back pain and right thigh pain
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MRI PRE OP
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CASE 2 - INTRA OP
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CASE 2- INTRA OP
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CASE 1 INTRA OP
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CASE 1 – PRE AND POST OP XRAY
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CASE 1 – PRE AND POST OP MRI (INDIRECT DECOMPRESSON)
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CASE 3 56 YO , 300 LBS, RECURRENT HNP
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CASE 3RECURRENT HNP
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CORTICAL BONE > CANCELLOUS BONE4-POINTS OF FIXATION
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CASE 3
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CASE 3
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MOTION PRESERVATION-ARTIFICIAL DISCFOR PATIENTS W DISC DEGENERATION
Charite’ (depuy) Prodisc (synthes)
Maverick (Medtronic) Flexicore (stryker)
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ARTIFICIAL DISC AND FUSION
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2 LEVEL CERVICAL ARTIFICIAL DISC
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POSTERIOR DYNAMIC STABILIZATION - DIAM
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FACET JOINT REPLACEMENT - IDE
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FACET JOINT REPLACEMENT
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COFLEX
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SPINAL STENOSIS81 YO F, TENNIS PLAYER
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DYNAMIC STABILIZATION
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THANK YOU