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XLIF + ILIF ®circumferential arthrodesis as a minimally invasive


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XLIF + ILIF ®circumferential arthrodesis as a minimally invasive

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XLIF + ILIF ®circumferential arthrodesis as a minimally invasive

  1. 1. XLIF + ILIF ®circumferential arthrodesis as a minimallyXLIF + ILIF ®circumferential arthrodesis as a minimally invasive fixation option: clinical results and imaging studyinvasive fixation option: clinical results and imaging study Nicola Zullo M.D. Functional Unit of Neurosurgery Clinica Eporediese-Policlinico di Monza Ivrea Spine Surgery Division Humanitas Gavazzeni Bergamo Chief: Corrado Musso M.D.
  2. 2.  01.01.2013-07.01.2014: 22 + 46 circumferential procedures  XLIF+ILIF®: 11 cases out of 22  Nine out of 11 patients meet the criteria of the present study, 8 patients were evaluated at least three months after surgery and were enrolled  VAS/ODI scores were collected pre and post operatively  Fusion rate was evaluated in 3 cases with lumbar CT scan
  3. 3. XLIF + ILIF® INDICATIONS  single level discopaty with or without central/foraminal stenosis (main treatment option)  Single level discopaty with Grade 1 spondilolystesis EXCLUTION CRITERIA  Spondilolystesis > grade 1  Spinal deformity (scoliosis, sagittal imbalance)  Multilevel discopaty
  4. 4. SURGICAL TECHNIQUE  Standard XLIF® procedure  Modified ILIF® (lateral or prone position)  If necessary, microsurgical uni or bilateral interlaminotomy /foraminotomy with spinous processes and articular sparing  ILIF ® modified technique:  Usually interlaminar spacer Magnitude device not used  Extensive removal of sopra and interspinous ligaments  Careful decortication of spinous processes and laminar boundaries  Interspinous space filled with Bone allograft (Attrax® putty or eterologous cancellous bone)
  6. 6. FOLLOW UP
  7. 7. FOLLOW UP
  8. 8. POST-OP CT SCAN pz1
  9. 9. POST-OP CT SCAN pz2
  10. 10. POST-OP CT SCAN pz3
  11. 11. CONCLUSIONS  XLIF® + ILIF® is a good, time sparing and minimally invasive fixation option for single level discopaty/grade 1 spondilolystesis  Overall clinical results are good; there’s no significant difference in clinical outcome between XLIF + ILIF and other circumferential constructs.  Surgical time, total blood loss and hospitalization are shorter then those observed in XLIF® + percutaneous pedicle screws or open techniques.  Evidence of fusion on post-op CT scan in one patient with bone growth in intersomatic space behind Co-Roent cage; no evidence of fusion in interspinous and interlaminar space after at least three month after surgery.  No evidence of subsidence of the cages with ILIF as posterior fixation choice.