病例讨论-OLIF1.pptVIP

病 例 讨 论 微创腰椎间融合手术（OLIF） 2012.11.9 宁波大学医学院附属医院 脊柱外一科 PRE-OP 病例特点-病史 女性，80岁，强迫体位，无法入眠 右侧腰腿痛3年，加重伴间歇性跛行3月 腰椎侧凸畸形，左/右SLR＝30°/70° 右足背触痛觉减退，右伸踇肌力III级 左/右膝反射＝+/+，左/右踝反射＝+/- PRE-OP  X-RAY PRE-OP  MRI 治疗方案 A 保守治疗无效－症状重，难以忍受 B 手术治疗 a 单纯髓核摘除术(MED/椎间孔镜/小切口) b 腰4/5髓核摘除，DYNESYS动态固定术 c P-T-D-X-ALIF OR ? OLIF Oblique Lumbar Interbody Fusion Anatomy of Kambin’s Triangle Posterior Border – SAP Inferior Border – Vertebral Endplate Superior Border – Exiting Nerve Distance From Midline Disc Space Preparation and Access Spinal Needle Access Ball Tipped Probe Access Guide Wire Access Blunt Dilator Access 9 mm Working Cannula Access All Done Through Kambin’s Triangle With Maximal Tissue Preservation Dilator Diameter is 8 mm Disc Drill removes disc nucleus and prepares disc space for other discectomy instruments. Rotating disc shaper passes through access portal and expands up to 16mm for endplate preparation Animation of shaper turning in disc space Pituitary rongeur grabs disc material after the rotating Disc Shaper is removed Preparation For Implant Insertion Instrumentation Allows a Thorough Discectomy Unique Minimal Access Instrumentation Allows Removal of Cartilaginous Endplate Preparation of a Bleeding Bone Bed Bone Grafting All Done Through a 9 mm Tube 9 mm Disc Cutter expands as a loop curette to deflect left, right, up and down for thorough discectomy. Add Bone graft material We have a collagen sponge infused with β-TCP and Hydroxyapatite and hydrated with bone marrow aspirate Proper placement of the Zeus-O is achieved when the radiographic markers are located on opposite sides of the spinous process in an A/P fluoro image. INTRA-OP