【腰椎融合技术】腰椎融合技术.pdf

PLIFandTLIF(POLAr)

LumbarFusionTechniques

•PosteriorLateral

•PLIF

•TLIF

•AnteriorStandAlone

•Anterior/Posterior

SurgicalApproachBasedUpon

•Results

•Complications

•Abilitytoattainfusion

•Cost

ImportanceofAnteriorColumnSupport

•FusionRate

•RestorePhysiologicLordosis

•ConstructStability

•CoronalReconstruction

IndicationsforInterbodyFusion

•DegenerativeDiscDisease

•Spondylolithesis

•Scoliosis

•FailedLaminectomies

•JunctionalDegeneration

InterbodyFusionApproach

•Posterior(PLIForTLIF)

•Casesofdegenerativediscdiseasewithsignificantposterior

pathologynecessitatingdecompressionofneuralelements

•Anterior(ALIF)

•Casesofaxialinstabilitysecondarytodegenerativediscdisease

withoutsignificantposteriorpathology

PLIFExposure

PLIF

TheCaseforPLIF

•AdvantagesoverTLIF

•Morecompletediscectomy

•Morestableconstruct(2cagevs.1cage)

•Betterabletoachievesagittal/coronalcorrection1

•AdvantagesoverALIF

•Higherfusionrate(v.stand-alone)2

•Novascularinjury3

•Novisceralinjury

•Lessbloodloss(v.360°)

•Decreasedoperativetime(v.360°)

1.Brantigan,etal,“Acheivementofnormalsagittalplanealignmentusingawedgedcarbonfiber

2.reinforcedpolymerfusioncageintreatmentofspondylolisthesis.”

3.Pavlov,etal,“Anteriorlumbarinterbodyfusionwiththreadedfusioncagesandautologousbone

4.Grafts.”EurSpineJ(2000)9:224-229

5.3McAfeeP.Interbodyfusioncagesinreconstructiveoperationsofthespine.JBJS,81A:859-880,1999

PLIFTechnicalTips

•Removeinferiorfacetsentirely

•Lessnerverootretraction

•Aggressivediscectomy

•Exposebleedingboneyetleaveendplatesintact

•Essentialtomaintainlordosis

•Jacksontablewithchest/pelvicboosters

•RadiolucenttableallowsAPlateralfluoro

TwoYearRe