scholarly journals Direct Pars Defect Tubular Decompression and TLIF for the Treatment of Low-Grade Adult Isthmic Spondylolisthesis: Surgical Challenges and Nuances of a Muscle-Sparing Minimally Invasive Approach

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Fabio Roberti ◽  
Katie Arsenault
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Low Grade ◽  
Lumbar Interbody Fusion ◽  
Isthmic Spondylolisthesis ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Muscle Sparing

We present an illustrative report on the use of a minimally invasive, muscle-sparing, direct pars defect decompression with transforaminal lumbar interbody fusion (TLIF) and instrumentation for the treatment of low-grade adult isthmic spondylolysis with spondylolisthesis and discuss the surgical challenges and nuances associated with the technique.

Transfacet Minimally Invasive Transforaminal Lumbar Interbody Fusion With an Expandable Interbody Device—Part I: 2-Dimensional Operative Video and Technical Report

2020 ◽  
Vol 19 (5) ◽  
pp. E473-E479
Author(s):  
Jawad M Khalifeh ◽  
Christopher F Dibble ◽  
Priscilla Stecher ◽  
Ian Dorward ◽  
Ammar H Hawasli ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Preoperative Imaging ◽  
Low Grade ◽  
Lumbar Interbody Fusion ◽  
Screw Insertion ◽  
Articular Process ◽  
Spinal Reconstruction ◽  
Indirect Decompression

Abstract BACKGROUND Advances in operative techniques and minimally invasive technologies have evolved to maximize patient outcomes and radiographic results, while reducing morbidity and recovery time. OBJECTIVE To describe the operative technique for a transfacet minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) as a proposed modification to the standard approach MIS-TLIF. METHODS We present the case of a 72-yr-old man with left-sided lumbar radiculopathy. Preoperative imaging demonstrated degenerative lumbar anterolisthesis at L4-5, with associated canal and neuroforaminal stenosis. The patient underwent transfacet MIS-TLIF at L4-L5. We describe the preoperative planning, patient positioning, incision and dissection, pedicle screw insertion, transfacet approach to the working access corridor, discectomy, interbody device placement, fixation, and closure. RESULTS The transfacet MIS-TLIF utilizes 3 key techniques to safely maximize surgical correction: (1) a limited bony resection based on the superior articular process, leaving the medial inferior articular process, lateral superior articular process, and rostral pars intact, providing a working bony corridor that protects the traversing and exiting nerve roots; (2) decortication and release of the contralateral facet joint to provide additional capacity for indirect decompression and provide the first point of osseous fusion; and (3) placement of an expandable interbody device that provides additional indirect decompression to the working side and contralateral foramen. CONCLUSION The transfacet MIS-TLIF uniquely leverages a bony working corridor to access the disc space for discectomy and interbody placement. Transfacet MIS-TLIF is a feasible solution for lumbar spinal reconstruction to maximize direct and indirect decompression of the neuroforamina and central spinal canal in patients with lumbar degenerative diseases and low-grade spondylolisthesis.

303 Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion: A Prospective Randomized Study

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 263-264
Author(s):  
Anthony Michael DiGiorgio ◽  
Gabriel Claudiu Tender
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Surgical Techniques ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Secondary Outcome ◽  
Low Grade ◽  
Oral Antibiotic ◽  
Lumbar Interbody Fusion ◽  
Estimated Blood Loss

Abstract INTRODUCTION Symptomatic spondylolisthesis patients may benefit from surgical decompression and stabilization. The standard (S) technique is a transforaminal lumbar interbody fusion (TLIF). Newer, minimally invasive (MI) techniques seem to provide similar results with less morbidity. However, prospective studies comparing S versus MI TLIF are rare. METHODS Patients with at least 6 months of symptoms and image-confirmed low-grade spondylolisthesis were enrolled, at a single academic institution, between 2011 and 2015. The patients were randomized to either S or MI TLIF. The primary outcome measure was the Oswestry Disability Index (ODI) improvement at 1 year. Secondary outcome measures included length of operation, estimated blood loss, length of hospitalization, and fusion rates at 1 year. Complications were also recorded. RESULTS >Forty patients were enrolled in each group. There was no crossover between groups. The age was 50.12 +/−11.09 years in the S TLIF group and 51.3 +/−9.36 years in the MI TLIF group. The mean operative time and estimated blood loss in the S versus MI TLIF group were 297 +/−101 versus 323 +/−85 minutes and 417 +/−211 versus 351 +/−198 ml, respectively. There were 4 transfusions in the S TLIF and 3 transfusions in the MI TLIF group. The patients were discharged after surgery at 4.12 +/−0.88 days for the S TLIF group and 1.92 +/−0.52 days for the MI TLIF group. The ODI improved from 37 +/−6 to 11 +/−6 in the S TLIF group (ODI difference: 26 +/−7) and from 38 +/−7 to 11 +/−6 in the MI TLIF group (ODI difference: 26 +/−8). In both groups, the fusion was considered solid (Grade I) in 36 (90%) and partial (Grade II) in 4 (10%) patients at 1 year. There were no reoperations for pseudarthrosis or any other postoperative complication. There were 2 superficial wound infections in the standard TLIF group, which resolved with oral antibiotic treatment alone. CONCLUSION The standard and minimally invasive TLIF in patients with symptomatic spondylolisthesis provided similar clinical and radiological outcomes at 1 year. The patients undergoing MI TLIF had a shorter hospital stay. Both surgical techniques yielded good results at 1 year.

Minimally invasive unilateral approach for bilateral decompression of spinal stenosis and modified transforaminal lumbar interbody fusion for degenerative spondylolisthesis

2013 ◽  
Vol 35 (v2supplement) ◽  
pp. Video4 ◽  
Author(s):  
Kevin S. Chen ◽  
Khoi D. Than ◽  
Frank LaMarca ◽  
Paul Park
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Spinal Stenosis ◽  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Invasive Approach ◽  
Unilateral Approach ◽  
Percutaneous Pedicle Screw

This video describes a minimally invasive approach for treatment of symptomatic grade I spondylolisthesis and high-grade spinal stenosis. In this procedure, a unilateral approach for bilateral decompression is utilized in conjunction with a modified transforaminal lumbar interbody fusion and percutaneous pedicle screw fixation. The key steps in the procedure are outlined, and include positioning, fluoroscopic positioning/guidance, exposure with tubular retractor system, technique for ipsilateral and contra-lateral decompression, disc space preparation and interbody grafting, percutaneous pedicle screw and rod placement, and closure.The video can be found here: http://youtu.be/QTymO4Cu4B0.

Minimally Invasive Transforaminal Lumbar Interbody Fusion: 2-Dimensional Surgical Video

2019 ◽  
Vol 17 (2) ◽  
pp. E53-E53
Author(s):  
Joseph H McMordie ◽  
Eric X Chen ◽  
Landon D Ehlers ◽  
Christopher C Gillis
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Patient Positioning ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Intraoperative Navigation ◽  
Radiographic Evaluation ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Invasive Approach ◽  
Percutaneous Pedicle Screw

Abstract This operative video is a detailed look at minimally invasive transforaminal lumbar interbody fusion. We provide a step-by-step guide with appropriate narration and operative video to enhance the educational experience. We review clinical and radiographic evaluation, patient positioning, intraoperative navigation, localization, percutaneous pedicle screw placement, minimally invasive approach, disc space preparation, placement of interbody device, and closure. By presenting up-to-date minimally invasive and intraoperative navigation techniques, this video provides educational benefit to all neurosurgeons regardless of training level.

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