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XLIF In The Treatment Of ddd


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XLIF In The Treatment Of ddd

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XLIF In The Treatment Of ddd

  1. 1. Dott. Nicola Zullo UF Neurochirurgia Clinica Eporediese Policlinico di Monza SS Neurochirurgia Ospedale U. Parini di Aosta Responsabile: dott. C. Musso
  2. 2. • Central nucleus poloposus: proteoglycan + water • Peripheral anulus fibrosus: concentric rings of collagenous lamellae intermingled with fibrous fibers • Avascular and aneural structure • Nutrients mainly diffuse through vertebral endplate
  3. 3. • Losening of water content in the central NP, progressive increase in fibrous fibers • Cracking of the peripheral anulus fibrosus (anular tears), Nitrogen incoming, nucleus polposus expansion • Areas of air density within the disc: due to nitrogen incoming, are signs of advanced degeneration • Possible outward extension of the nucleus polposus through anular tears: disc disruption • Height reduction • Nerve and vascular ingrowth: discogenic back pain • Discal degeneration leads to osseus degeneration
  4. 4. Progressive disc degeneration: loss of disc height and inflammatory mediators formation Endplates closer to one another Endplates fissuring and disruption Formation of fibrovascular granulation tissue, vascular density and sensory nerve fibers increase Facet joint hypertrophy and cartilage loss Abnormal movement of the spinal funcional unit Osteophytes formation with central canal and neuroforamina narrowing Ligamentum flavum hypertrophy
  5. 5. • Modic1: hyperintense in T2, hypointense in T1 w. Images; water content increase, inflammatory response • Modic 2: hyperintense in T1 and T2 w. Images; conversion of BM to adipose tissue due to BM ischemia • Modic 3: hypointense in T1 and T2 w. Images; subcondral bone sclerosis
  6. 6. • 21 patients treated with Xlif in one year • Diagnosis: 19 DDD and 2 degenerative scoliosis • Pre-operative clinical evaluation, ODI, VAS back and VAS leg administration • Follow up criteria: diagnosis of DDD, clinical evaluation at 1 month post-op, ODI, VAS back and VAS leg at three and six month post-op., X-ray films in a-p and l-l at three month post-op. • 15 patients matched the FU criteria and were enrolled in the study (8 males, 7 females).
  7. 7. 11 1 1 2 Construct Xlif stand alone Xlif + LP Xlif + bilateral PSF Xlif + ILIF
  8. 8. 15 5 Clinical symptoms LBP Radicular symptoms
  9. 9. 0 2 4 6 8 10 12 14 16 18 20 ODI Vas Back Vas Leg pre 3 6
  10. 10. • Ipsilateral transitorial muscular strength reduction: 6 • No major nerve injury, no wound infection, no spondylitis • Numbness of the ipsilateral lower limb: 7 cases • Numbness of controlateral lower limb: 2 cases • Transitorial ipsilateral lower limb vasodilatation • Implant disruption: 4 cases (3 8mm cages, 1 10 mm cage) • Subsidence: 3 cases (1 patient worsened, two improved) Remember the trajectory during the cotrolateral anulus fibrosus realease manoeuvre
  11. 11. • Overall complication rate: form 2 to 30,4% • Minor complications: about 20% • Major complications: about 8.6% • Most frequent complications: thigh symptoms from 0.7 to 60.1%
  12. 12. • DDD with disc bulging causing lumbar pain and/or raduclopaty • After microsurgical erniectomy for recurrent disc erniation • Alternative to PLIF:: prevention of muscular injury and denervation • Alternative to TLIF: ligament sparing • Alternative to ALIF: large surface and bone graft volume, with ALL integrity, reduced risk of vascular injury • Spondylolistesis less than grade 2. Minimal access surgery: decrease blood loss, shorter operative time, reduce post-op. pian, shorter recovery, rapid mobiization. low major complication rate
  13. 13. Stand alone XLIF