Marc J. Levine, MD Rothman Institute Director Spine Surgery - PowerPoint PPT Presentation

Marc J. Levine, MD Rothman Institute Director Spine Surgery Program-Robert Wood Johnson University Hospital-Hamilton

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SYMPTOMS MRI AXIAL 50% Low Back Pain 50% Right Leg  Pain Neurogenic Claudication –relieved  sitting Failed Non-operative treatment 

LATERAL RECESS FORAMINAL STENOSIS STENOSIS  Sagittal MRI  Sagittal MRI

BACK PAIN LEG PAIN  Lateral Recess Stenosis  Facet Arthropathy  Facet arthropathy  Micromotion  Ligamentous hypertrophy  Degenerative Disc  Foraminal Stenosis Disease  Collapsed disc height Positional ANSWER FUSION - flexion better -extension worse DECOMPRESSION DIRECT/INDIRECT

Percutaneous Wire  Placement Unilateral Screw Placement  Facectectomy  Lateral and Foraminal  Decompression Disc Space Preparation  Interbody Graft and Device  Placement Rod Placement  Contralateral Construct  Completion

Back Pain(facet/micromotion/- Fusion Leg Pain -lateral recess (decompressed) -foraminal (direct and indirect) Neurogenic -positional

Decrease hospital days  Decrease hospital cost  Decrease 2 year cost  Quicker RTW 

Less Blood Loss  Less Transfusions  Less Pain Med Requirements  Less Muscle Dissection  Clinical Benefits 1-2 years  Similar Long Term Benefits  LESS PHYSICIAN WEAR  AND TEAR

Identify exiting L4 nerve root  Identify traversing L5 nerve  root Beware of abnormal  anatomy Beware of nerve “shift” with  spondylolisthesis

Learning Curve  Retractor Choices Endplate Preparation Interbody Choices

Djurasovic M, Rouben DP, Glassman SD, Casnellie MT, Carreon LY 1 .Clinical Outcomes  of Minimally Invasive Versus Open TLIF: A Propensity-Matched Cohort Study . Am J Orthop (Belle Mead NJ). 2016 Mar-Apr;45(3):E77-82.   Terman SW, Yee TJ, Lau D, Khan AA, La Marca F, Park P.J Minimally invasive versus open  transforaminal lumbar interbody fusion: comparison of clinical outcomes among obese patients. Neurosurg Spine. 2014 Jun; 20(6):644-52. Epub 2014 Apr 18.   Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR. Perioperative outcomes and  adverse events of minimally invasive versus open posterior lumbar fusion: meta- analysis and systematic review. J Neurosurg Spine. 2016 Mar; 24(3):416-27. Epub 2015 Nov 13.   Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and  outcomes. Karikari IO, Isaacs RE.Spine (Phila Pa 1976). 2010 Dec 15; 35(26 Suppl):S294-301. 