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Degenerative Disc Disease - 360 Spinal Fixation
- 1. Degenerative Disc DiseaseDegenerativeDisc Disease -- 360360οο Spinal FixationSpinal Fixation GEORGE SAPKAS ASC. PROFESSOR 1st Orthopaedic Department Medical School-Athens University Attikon Hospital Metropolitan Hospital Athens Greece
- 2. InterverterbralInterverterbral disc space –foramendisc space – foramen progressive stenosis and neuralprogressive stenosis and neural compressioncompression
- 3. Disc - Facetdegeneration - StenosisDisc - Facet degeneration - Stenosis
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- 6. Degenerative Adult ScoliosisDegenerativeAdult Scoliosis
- 7. Sites of painorigin
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- 11. Plain x-raysPlain x-raysDynamic x-raysDynamic x-rays
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- 13. CT - scanCT- scan 3D - scan3D - scan
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- 17. Psychological investigationPsychological investigation Paindrawing Pain drawing M.M.P.I.
- 18. OswestryOswestry Rolland MorrisRolland Morris SP-36SP-36 Functional– Disability questionnaires
- 19. LUMBAR DDDLUMBAR DDD TREATMENTOPTIONSTREATMENT OPTIONS
- 21. Conservative treatmentConservative treatment NSAIDSNSAIDS Injections- Facet’s BlockInjections - Facet’s Block Epidural - Caudal injectionEpidural - Caudal injection BraceBrace Psychological supportPsychological support Social supportSocial support Rehabilitation programmRehabilitation programm
- 22. When do weoperate theWhen do we operate the degenerative disease ?degenerative disease ? 1.1. Pain not responding toPain not responding to conservative treatment,conservative treatment, lasting more than 3 monthslasting more than 3 months 2.2. Non improving neurologicNon improving neurologic deficitdeficit 3.3. Persistence or deteriorationPersistence or deterioration of symptoms of intermitentof symptoms of intermitent claudicationclaudication 4.4. Significant restriction of theSignificant restriction of the common daily working andcommon daily working and social activitiessocial activities
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- 25. InstabilityInstability A. Total laminectomyA.Total laminectomy Vertebral olisthesesVertebral olistheses (65% & 20%)(65% & 20%) Johnson et al Spine 1992Johnson et al Spine 1992 Re-operationRe-operation : 17%: 17% ptspts Intensive painIntensive pain : 30% >> 3-6: 30% >> 3-6 yrs popyrs pop Ketz et al JBJS 1991Ketz et al JBJS 1991 Airaksihen et al Spine 1996Airaksihen et al Spine 1996 Simpson et al JBJS 1993Simpson et al JBJS 1993 Spivak et al JBJS 1998Spivak et al JBJS 1998 ContraindicationContraindication :: multiple levelsmultiple levels Paine et al Clin Orthop 1976Paine et al Clin Orthop 1976 Sanderson et al JBJS 1993Sanderson et al JBJS 1993 B. FacetectomyB. Facetectomy
- 26. Post Facetectomies –Laminectomies InstabilityPost Facetectomies – Laminectomies Instability
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- 28. Post Laminectomy LumbarInstability
- 29. Post Laminectomies -Facetectomies InstabilityPost Laminectomies - Facetectomies Instability
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- 32. Spondylodesia with internalfixationSpondylodesia with internal fixation and postero-lateral graftingand postero-lateral grafting
- 33. Laminectomy + spondylodesiaLaminectomy+ spondylodesia ++ Transpedicular stabilization withTranspedicular stabilization with semi-rigid rod (PEEK) andsemi-rigid rod (PEEK) and postero-lateral graftingpostero-lateral grafting
- 34. LumbarLumbar IntervertebralIntervertebral FusionFusion (PLIF – TLIF– X-LIF)(PLIF – TLIF – X-LIF)
- 35. The goals areto:The goals are to: a)a) Restore the height of theRestore the height of the intervertebral disc spaceintervertebral disc space b)b) Restore the width of theRestore the width of the intervertebral foramenintervertebral foramen c)c) Achieve the maximumAchieve the maximum stability and rigiditystability and rigidity d)d) RelocateRelocate the subluxatedthe subluxated jointsjoints e)e) Restore lumbar lordosisRestore lumbar lordosis f)f) Restore, close to normalRestore, close to normal the loads on the anteriorthe loads on the anterior vertebral columnvertebral column
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- 37. Laminectomy- PLIFLaminectomy- PLIF andand Transpedicularrigid stabilizationTranspedicular rigid stabilization
- 38. Laminectomy- PLIFLaminectomy- PLIF andand Transpedicularhybrid stabilizationTranspedicular hybrid stabilization (rigid +dynamic)(rigid +dynamic) B.T. – O. system + Disc – O – Tech expandable cage
- 39. Anterior-posterior decompressionAnterior-posterior decompression andstabilizationand stabilization
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- 41. Minimally Invasive LumbarMinimallyInvasive Lumbar Fusion & FixationFusion & Fixation
- 42. Minimally Invasive LumbarMinimallyInvasive Lumbar FusionFusion Achieve the sameAchieve the same goals as open fusiongoals as open fusion while minimizingwhile minimizing approach-relatedapproach-related morbiditymorbidity (“fusion disease”)(“fusion disease”)
- 43. SextantSextant RodRod InsertionInsertion SystemSystem Foley KT, GuptaSK, Justis JR, Sherman MC. Percutaneous pedicle screw fixation of the lumbar spine. Neurosurg Focus 10(4): 1-8, 2001. Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. Journal of Neurosurgery 97(Spine 1): 7-12, 2002.
- 44. Clinical ApplicationClinical Application Maybe used anytime pedicleMay be used anytime pedicle fixation is felt to be necessaryfixation is felt to be necessary and/or desirableand/or desirable Posterior supplementation for:Posterior supplementation for: ALIF,ALIF, minimally invasive PLIF,minimally invasive PLIF, minimally invasive TLIFminimally invasive TLIF Supplement to minimallySupplement to minimally invasive posterolateral fusioninvasive posterolateral fusion
- 45. Sextant Rod InsertionProcedureSextant Rod Insertion Procedure Initial incisionInitial incision
- 46. Sextant Rod InsertionProcedureSextant Rod Insertion Procedure Awl and probe pedicleAwl and probe pedicle Insert guide wiresInsert guide wires
- 47. Sextant Rod InsertionProcedureSextant Rod Insertion Procedure Rod insertion incision and pathRod insertion incision and path
- 48. Sextant Rod InsertionProcedureSextant Rod Insertion Procedure Insert rodInsert rod
- 49. Sextant Rod InsertionProcedureSextant Rod Insertion Procedure Final constructFinal construct
- 50. METRxMETRx –– Sextant PercutaneousPLIFSextant Percutaneous PLIF
- 54. TLIFTLIF Adult degenerative Kyphosis– ScolioisisAdult degenerative Kyphosis – Scolioisis (+) Parkinson(+) Parkinson
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- 61. AxiaLIF Trans 1 Axial Lumbar Interbody Fusion Least invasiveaccess Safe, Reproducible, Pre-Sacral Approach Soft-tissue sparing Dynamic decompression via distraction Immediate rgid segmental stabilization
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- 64. 360360οο Spinal fixationSpinal fixation PLIF+ALIFPLIF+ ALIF XLIF +XLIF + PosteriorPosterior StabilizationStabilization PLIF +PLIF + PosteriorPosterior StabilizationStabilization TLIF +TLIF + PosteriorPosterior StabilizationStabilization Trans 1 +Trans 1 + PosteriorPosterior StabilizationStabilization
- 65. No conclusions areNoconclusions are possible :possible : about the relativeabout the relative effectiveness of anterior,effectiveness of anterior, posterior, orposterior, or circumferential fusion.circumferential fusion. Blumental SL, et al, Spine 1993 Kant AP., et al, Spine 1995 Schorfferman J. et al, Spine 2001 Bono CM et al, Spine 2005 Gibson JN, et al, Updated Cohraming Review, Spine 2005
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