spinal fusion ppt

transforaminal lumbar interbody fusion (TLIF)

spinal fusion surgery that creates solid bone and eliminate motion in a spinal segment.  Procedure addresses disabling pain caused by spondylolisthesis, degenerative disc disease, and/or recurrent disc herniations.

what does TLIF stand for

transforaminal (surgical approach through the hollow bony openings foramina between adjacent spinal segments) lumbar (on the lumbar spine), interbody (area between 2 adjacent vertebral bones in the spin), fusion (two bones becoming one)

what may a TLIF procedure be indicated for?

spondylolisthesis, degenerative disc disease, recurrent disc herniations, and pseudo arthritis

when is TLIF the preferred approach instead of posterior lumbar interbody fusion?

when disc degeneration is predominately one-sided

what are contraindications for TLIF

extensive epidural scarring, arachnoiditis (inflammation of the spinal canal), active infection, conjoined nerve roots, and osteoporosis

incision for TLIF procedure for unilateral open approach

single incision midline at the level of affected intervertebral disc

incisions for bilateral MIS approach for TLIF

two small incisions on either side of the midline by the affected disc

what does a lateral approach for TLIF allow?

access to the damaged disc and delivery of bone graft with minimal retraction of nerves

interbody spacers for TLIF

static or expandable spacer may be inserted into the disc space, a cage to restore normal disc hight, open the nerve foramina and re-establish spinal alignment, the cage will take pressure off the nerve root

pedicle screw for TLIF

attached to rods or plates, stabilize the vertebra of segment spine, which holds the motion of that spinal segment in place, this allows the bone graft to fuse the vertebra segment

MIS TLIF

small incisions with less muscles dissection, reduced postoperative pain, and faster recovery and return to activities

what is the goal of MIS TLIF

to decompress the nerve root, decompress the thecal sac, insert an interbody cage, and stabilize the segment with percutaneous pedicle screw instrumentation

why are topical steroids not recommended for MIS TLIF?

to not interfere with the fusion process

what is the difference between TLIF and PLIF procedures?

PLIF the disc is removed from the midline with retraction of nerve roots, TLIF is approached from the side with little or no nerve root retraction

what are surgical alternatives to TLIF include?

decompression (laminectomy), lateral lumbar interbody fusion (LLIF), anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), and posterolateral fusion (PLF)

posterior lumbar interbody fusion (PLIF)

removes disc and fuses segments of vertebrae with interbody cage, screws, and rods, open midline incision or MIS with multiple small incisions

what are pathologies for PLIF?

DDD, spondylolisthesis, scoliosis, recurrent herniation disc

what is the difference between PLF and PLIF fusion?

PLF an interbody spacer is not placed and rods/screws are inserted to complete spinal fusion

lateral lumbar interbody fusion (LLIF)

MIS procedure removes disc and fuse 2 vertebra above and below disc removed, fusion achieved with interbody spacer along with posterior screws and rods, single of multilevel vertebrae may to fuse with LLIF

advantages of lateral lumbar interbody fusion approach

smaller incision with less disruption of muscles and tissues, reduced risk to major blood vessels and visceral organs, safer and decreased anesthesia, helps maintain spine’s stability and function, allow for better correction, decreases infection risk

what are risks of a LLIF procedure

insufficient bone fusion (nonunion), in addition to risk with spinal surgery discussed early

anterior lumbar interbody fusion (ALIF)

spinal fusion through the abdomen to access the front of the spine and fuse two or more vertebrae in the lower back together, involves general and neuro surgeon

what is the pathology for ALIF

radioculopathy (compressed nerve), DDD, spondylosis, and scoliosis

incision for ALIF?

horizontal or vertical abdominal incision

what is done with the patient when additional hardware needs to be inserted during an ALIF procedure?

patient is turned prone

interbody cages

are cylindrical or crescent-shaped, hollow, and porous metallic devices  placed between two vertebrae after removing the damaged disc, may fill the entire disc space of just the anterior part, is filled with bone graft material that is harvested from patient or allograft that grows over time and fills within the interbody space, permanently fusing the two adjacent vertebrae

risks and possible complications of a spinal cage include

all possible risks of spinal surgery, rarely, they are subject to breakage or dislodgment