How my practice has changed in adult degenerative diseases Satellite meeting Euro Spine Barcelona 2018

1. UNID or not UNID
How my practice has changed in
Adult Spinal Degenerative Diseases
M Triffaux
Tournai Belgium
20 / 09 / 2018

2. A question of lordosis?

3. A question of lordosis?
• What is the best lordosis to give ?
• How to calculate the lordosis to need ?
• Equation : LL = 0,45 x PI + 31,8
Spine 201; 41:E211-E217

4. A question of lordosis?
• What do you need to make a good planning?
• Rx Full Spine
But easier said than done
? C7 Plumb line SVA
? Femoral heads
Arms position
Keep standing position
Rx magnification factor

5. A question of lordosis?
• What do you need to make a good planning?
• Rx Full Spine with calibration sphere
for accurate planning

6. A question of lordosis?
• What do you need to make a good planning?
• Rx Full Spine

7. A question of lordosis?
• What do you need to make a good planning?
• Rx Full Spine
Eq dose ?? Full spine
=> EOS: 3D, Radition dose divide by 10

8. A question of lordosis?
• If you know the best lordosis
• How are you going to get it ?
• Wath kind of approach will you choose ?
• ALIF
• PLIF
• TLIF
• DLIF
• Osteotomy

9. A question of lordosis?
• How many degrees get it with
- Posterior approach ?
PLIF
TLIF
- Anterior approach ?
ALIF
OLIF
DLIF
- Osteotomy ?

10. A question of lordosis?
• How many degrees get it with
- Posterior approach
PLIF 5-10°
TLIF 5-10° 15° with arthrectomy?
- Anterior approach
ALIF 10-20° ALL open
OLIF 10°
DLIF 10° ALL intact
- Osteotomy => 30 ° PSO

11. A question of lordosis?
• How to bend the rod ?
Manually whith a bender with a simple
visual control ?
Idem with a template ? Whith a scale 1/1
How to get the right scale without
geometric facteur ?

12. A question of lordosis?
• How to bend the rod ?
• Not easy to have a good accuracy
• Impossible to have the same two rods

13. A question of lordosis?
• How to bend the rod ?

14. A lot of questions !
• Before I opereted everything by a posterior
approach: PLIF TLIF
• My masters taugth me that everything could
be treated by a posterior approach:
No anterior approach during my training.
• Surgery without any question:
Keep the same approach for evrything
it’s very easy BUT …

15. A question of lordosis?
• Whith a posterior approach you risk to fix
your patient in a bad postion with not
enough lordosis
• It’s not too bad for 1 level
• Now I ask myself more and more questions
and I’m not always sure of my answers

16. What UNID has changed
• Each patient is unique
• Every patient should receive a specific surgery
• The arthrodesis of one is not that of another
• Ready for UNID attitude ?

17. My first 33 UNID
F= 17 H= 16 61 4,4 8 >= 6 n 2n = 5 3N= 9
4n = 8 5n= 3
33 HM F 46 2
32 JL M 70 8
31 WP M 58 8
30 VM F 52 2
29 CC F 64 8
28 VM M 58 4
27 GA M 70 6
26 MN F 73 4
25 WA M 58 2
24 LE F 73 8
23 LM F 61 3
22 GT M 63 3
21 TB M 53 3
20 DA F 59 8
19 CL F 71 4
18 PC F 61 5
17 CG M 42 2
16 VS F 45 4
15 CP F 65 7
14 FC F 55 3
13 GM M 64 3
12 CA M 68 8
11 SA M 64 4
10 MD F 62 5
9 YS M 68 4
8 RM F 49 3
7 VM M 66 3
6 AP M 79 3
5 JB M 72 4
4 MJ M 68 5
3 XX F 48 3
2 MH F 64 2
1 AB F 49 4
N = 33 F= 17 , M= 16
61 y.o. 46 – 79
2 levels 5
3 levels 9
4 levels 8 4,4 levels
5 levels 3
6 >= 8

18. The Unid attitude
• 1 level: TLIF how many lordosis can give ?

19. The Unid attitude
• 1 level: TLIF + arhtrectomy: 17° lordosis
• No UNID rods for 1 level but this the unid spirit

20. The Unid attitude 2 levels
• Lumbar stenosis
• Laminectomy L4L5
• PLIF L5S1

21. The Unid attitude 2 levels

22. The Unid attitude 2 levels
• 1 year after

23. The Unid attitude
• Spondylo L5S1 grade II: UNID rods L4S1

24. The Unid attitude
• Spondylo L5S1 grade II: UNID rods L4S1

25. The Unid attitude
• Spondylo L5S1 grade II: UNID rods L4S1

26. The Unid attitude
• Hybrid surgery percut MIS pass / Open PLIF

27. The Unid attitude
• Hybrid surgery percut MIS pass / Open PLIF

28. The Unid attitude
• Hybrid surgery percut MIS pass / Open PLIF

29. The Unid attitude
• Xlti levels

30. The Unid attitude
• Xlti levels

31. The Unid attitude
• Xlti levels

32. The Unid attitude
• Xlti levels

33. What UNID does not prevent
• PJK with a unsuffisant construct
• Loosing S1 => S1S2 plate

34. Pratically what I do
1. My mind planning:
• Number of levels to treat
• How to treat:
• Decompression direct or indirect
• Pedicular fixation
• Kind of LIF: PLIF, TLIF, DLIF ALIF
2. transfert Rx data by internet link with my
planning TO UNID lab
3. Confirm to UNID lab the surgery
4. Validate the UNID planning

35. Pratically what I do
Discussion by UNID lab by three ways
1. Mail
2. UNID Hub app smart phone
3. UNID Hub app PC

36. I have a dream…
• I hope more of AI
• Spine surgery must not a technical problem
It is the planning the problem
You can’t treat musculo ligament complex
UNID it’s not enough for man but one giant leap
for spine surgery

37. Thank you