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Gr 1 lumbar spondylolisthesis Traetment plan
Degenerative
Only decompression will increase more instability
Interspinus devices :
Traditional fixation fusion with TLIF
MISS
How to select case for MISS Mono radiculopathy with predominant back pain due
to instability
Not useful in multilevel severe lumbar canal stenosiswith bilateral stenosis
? Lysis dilema always
Full facet sign on MRI
Advantages Reduced intraoperative Blood Loss
Reduced postoperative drain
Less Post operative Back pain
Less Pain during Rehabilitation
Reduced hospital Stay
Less multifidus muscle atrophy
Decreased incidence of surgical site infections
Procedure Step 1
Mark pedicles and entry points made using trocars percutaneously.
Dilators are inserted and screws and rods inserted bilaterally same procerdure used.
The side from where disc is removed a larger incision taken and tubular retractors used to remove disc and insert cage.
Under GA prone position
Operative time 2hr 30 min initial cases
Now 1hr 30 min
Avg Blood loss 50 cc
anasthesia and analgesia requirement was less during procedure
No drain
Problems I have faced initially Scared for c arm exposure
2 cases I have to open paraspinally as rod introducer broken
Screws not like mirror image on xray
? Decompressed completely or not
I m happy about No dural leak in any case
no Screw mal position giving rise to neuralgic pain or defecit
Mobilization quick
Pain over opt site drastically reduced
disadvantages Significant learning curve
Pseudarthrosis could be due to the more difficult disc space preparation and grafting using tubular retractors
Pedicle screw malposition, cage displacement and iatrogenic foraminal stenosis (14.2%)
Increased radiation exposure
Duration of surgery greater than conventional open technique (3 Hrs after training nearly 1-1.5hrs reduction in earlier time).
References Mid-term clinical results of minimally invasive decompression and posterolateral fusion with percutaneous pedicle
screws versus conventional approach for degenerative spondylolisthesis with spinal stenosis. Kotani Y, Abumi K, Ito M, Sudo H, Abe Y, Minami A.
A minimally invasive posterior lumbar interbody fusion using percutaneous long arm pedicle screw system for degenerative lumbar disease. He EX, Cui JH, Yin ZX, Li C, Tang C, He YQ, Liu CW.
Slip Reduction Rate between Minimal Invasive and Conventional Unilateral Transforaminal Interbody Fusion in Patients with Low-Grade Isthmic Spondylolisthesis Chang Hyun Oh, Gyu Yeul Ji, Jae Kyun Jeon, Junho Lee,Seung Hwan Yoon, and Dong Keun Hyun
Mid-term clinical results of minimally invasive decompression and posterolateral fusion with percutaneous pedicle screws versus conventional approach for degenerative spondylolisthesis with spinal stenosis. Kotani Y, Abumi K, Ito M, Sudo H, Abe Y, Minami A.
Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement. Babu R, Park JG, Mehta AI, Shan T, Grossi PM, Brown CR, Richardson WJ, Isaacs RE, Bagley CA, Kuchibhatla M, Gottfried ON.
Clinical study on lumbar spondylolisthesis treated by minimally invasive transforaminal lumbar interbody fusion. Wang J, Zhou Y, Zhang ZF, Li CQ, Ren XJ, Chu TW, Wang WD, Zheng WJ, Pan Y, Huang B.
Comparison of instrumented posterolateral fusion versus percutaneous pedicle screw fixation combined with anterior lumbar interbody fusion in elderly patients with L5-S1 isthmic spondylolisthesis and foraminal stenosis. Shim JH, Kim WS, Kim JH, Kim DH, Hwang JH, Park CK.
Adjacent segment degeneration after lumbar interbody fusion with percutaneous pedicle screw fixation for adult low-grade isthmic spondylolisthesis: minimum 3 years of follow-up. Bae JS, Lee SH, Kim JS, Jung B, Choi G.
Two-level anterior lumbar interbody fusion with percutaneous pedicle screw fixation: a minimum 3-year follow-up study. Lee DY, Lee SH, MaengDH.
Minimally invasive anterior lumbar interbody fusion followed by percutaneous pedicle screw fixation for isthmicspondylolisthesis: minimum 5-year follow-up. Kim JS, Choi WG, Lee SH.
Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Kim DY, Lee SH, Chung SK, Lee HY.
Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. Schwender JD, Holly LT, Rouben DP, Foley KT.
Surgeons' Exposure to Radiation in Single- and Multi-Level Minimally Invasive Transforaminal Lumbar InterbodyFusion; A Prospective Study Haruki Funao, Ken Ishii,,* Suketaka Momoshima, Akio Iwanami, Naobumi Hosogane,Kota Watanabe, Masaya Nakamura,YoshiakiToyama and Morio Matsumoto
References Comparison of one-level minimally invasive and open
transforaminal lumbar interbody fusion in degenerative and isthmicspondylolisthesis grades 1 and 2 Jian Wang, Yue Zhou, Zheng Feng Zhang, Chang Qing Li, Wen Jie Zheng, and Jie Liu
A minimally invasive posterior lumbar interbody fusion using percutaneous long arm pedicle screw system for degenerative lumbar diseaseEr-Xing He,Ji-Hao Cui, Zhi-Xun Yin, Chuang Li, Cheng Tang,Yi-Qian He, and Cheng-Wei Liu
Minimally invasive transforaminal lumbar interbody fusion.Resultsof 23 consecutive cases Amit Jhala, Damandeep Singh, and MS Mistry
Surgical Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Spondylolisthesis and Degenerative Segmental Instability Yung Park, Joong Won Ha, Yun Tae Lee, Hyun Chul Oh, Ju Hyung Yoo, and Hyung Bok Kim
Minimal access bilateral transforaminal lumbar interbody fusion for high-grade isthmic spondylolisthesisN. A. Quraishi and Y. Raja Rampersaud
Quality-of-Life Outcomes With Minimally Invasive TransforaminalLumbar Interbody Fusion Based on Long-Term Analysis of 304 Consecutive PatientsMick J. Perez-Cruet, MD, MS, Namath S. Hussain, MD, G. Zachary White, BS, Evan M. Begun, BS, Robert A. Collins, DO, Daniel K. Fahim, MD, Girish