Webinar Auxin 15.12.2021 A new aid for revision spine surgery with more selective dissection. Our experience more than10 cases: ideal case to start and bad case with limitation of the system Additional direct cost of ADTs

1. Cadiss®, a new aid for revision spine surgery
with more selective dissection
M. Triffaux
Neurosurgery, Spine Unit
CHwapi B 7500 Tournai
15 december 2021

2. Spinal revision a real challenge
• Spinal revision surgery is complexe and ungrateful
• Spine surgery is a succesion of small details
• Epidural fibrosis and dural tears always remain a difficulty
• Good results are not always there

3. Spinal revision a real challenge
• Pre op evaluation
• Change the approach ?
• Keep the bone contact
• Do not tear off
• Dissolve fibrosis ?

4. Our experience more than 10 cases
Niveau: L2 L3 L4 L5 S1
Dispositif CADISS Auxin
Etude prospective 04.21
CAS __ __ AB SL MT
date op. : __ / __ / 2021
1. compléter Spine Tango dans HD4PD
2. Dans §4 Chirurgie technique item autre: CADISS
3. ATCD infiltratif O non O inconnu O oui __ __ __ __ __ __ __ __ __
4. ATCD opératoire O non
O oui O même niveau O prévention par oxyplex, __ __ __ __ __ __ __
O type intervention précédante: O HDL O CLE O Fusion
O alt: __ __ __ __ __ __ __ __ __ __ __ __ __ __
délai entre les deux interventions __ __ mois __ __ années O non connu
5. Type d’intervention O HDL O CLE O FUSION 180° O à 360° O trauma
6. Modalités opératoires O open O MIS O NNV O arm
O autre: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
8. Fibrose canalaire O IRM O Ctscan O non évaluable
A: 100 %. B: 75% C: 50% D: 25%
4 / 16 3 / 16 2 / 16 1/ 16
A B C D Total
___ /16 ___ /16 ___/16 ___/16 ___/16 _____ %
/16 % /16 %
2 13 10 63
4 25 12 75
6 38 14 88
8 50 16 100
1./2

5. Our experience more than 10 cases
• Our 10 consecutive cases with Cadiss®
6 month period, 10 / 291 = 3,5 % , ADTs 1 with BS 10 %

6. Our experience more than 10 cases
• Ideal case to start:
Posterior Interbody Fusion for late reccurent disc hernia

7. Our experience more than 10 cases
• Ideal case to start:
Posterior Interbody Fusion for late reccurent disc hernia

8. Our experience more than 10 cases
• Another case if you are not convinced: try on implants
It’s even easier to see the work of the Cadiss®

9. Our experience more than 10 cases
• Reccurent lumbar disc herniation
• 36 y.o. women
• Surgical cure of right lumbar disc L5S1 herniation -3 y.
• Left radiculalgia improve with conservative treatment
but right S1 radiculalgia increases with failure of
conservative treatment

10. Our experience more than 10 cases
• Reccurent lumbar disc herniation
R L5/S1 L
S1 g
S1 dr
HDL
Ancien abord
Ctscan récidive HDL5S1 droite dd fibrose épidurale post op
S1 g
S1 dr
HDL
HDL
Ancien abord

11. Our experience more than 10 cases
• Reccurent lumbar disc herniation

12. Our experience more than 10 cases
• Reccurent lumbar disc herniation
2018 2020

13. Our experience more than 10 cases
• Another case : reccurent lumbar disc herniation
• Our choice: only sequestromy of reccurent L D H
fibrosis
S1 DH

14. Our experience more than 10 cases
• Reccurent lumbar disc herniation

15. Our experience more than 10 cases
• A bad case :
67 y.o. man with comorbidity ++
1992 First arthrodesis L4L5
2008 AMOS Laminectomy L2L3L4 // DH L2L3
2019 Laminectomy Th12 L1 re L1L2L3L4: ADT
2021 Neurogene claudication

16. Our experience more than 10 cases
• A bad case :

17. Our experience more than 10 cases
• A bad case :

18. Our experience more than 10 cases
• A bad case :

19. Our experience more than 10 cases
• A bad case :
X
X
X
X

20. The Cadiss® wath can and cannot do
This can facilitate dissection in epidural fibrosis
BUT 1. minimize the thicknes of epidural fibrosis
2. take the time for the product to work
3. wash the operative area with PL
AND 1. reduce the operating time
2. reduce the ADTs, reduce bleeding
3. reduce the lenght of hospital stay
It is same as the hemostatic product, you always need to do a
good hemostasis: a careful dissection always be done

21. 10 consecutive ADTs study
• The additional direct cost of the ADTs
Study on the hospital bill of 10 consecutive ADTs cases
3 month period : 10 ADTs/ 167 = 6%

22. • The additional direct cost of the ADTs
Study on the hospital bill of 10 consecutive ADTs cases
Population: Revision 3 , trauma 1 : B2 Th L
10 consecutive ADTs study

23. • The additional cost of the ADTs
Study on the hospital bill of 10 consecutive IDTs cases
Additional direct cost / ADTS: 1.388 €
10 consecutive ADTs study

24. Thank you