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2015-12-28

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MIS TLIFTIndications Pitfalls and Results

Hyeun Sung Kim, MD, PhD,Ji Soo Jang, MD, PhD, Jung Hoon Choi, MD, Sung Kyun Jung MD, Jung Sub Lee, MD

Department of Neurosurgery, Nanoori Hospital, Suwon City, South Korea

Medical College of Chosun University , Gwangju, South Korea (1994) / Board of Neurosurgery (1999)

MEMBERSHIPS & PROFESSIONAL SOCIETIES

Korean Neurosurgical Society / Korean Spinal Neurosurgery Society / Korean Minimal Invasive Spine Surgery Society / Korean Society of Peripheral

Nervous System / Korean Spinal Deformity Research Society / Korean Spinal Osteoporosis Research Society / NASS / Eurospine / ISASS / AO Spine /

AANS / AANS/CNS Section on Disorders of the Spine & Peripheral Nerves / World Spine Society / WCMISST / ACMISST / ISMISS KOREA, TURKEY,

JAPAN / Korean Society of Thermology / Korean Pain Society / Korean Neuro-Pain Society / The Korean Society of IMS

Best article award in the Korean Neurosurgical Society / Best Paper Award in the 6h ISMISS TURKEY / Best article award in The Korean IMS Therapy Association

AWARDS

Kim HS et al. Balloon kyphoplasty in severe osteoporotic compression fracture: Is it a contraindication? Neurosurgery 2007

Kim HS et al. Bone Cement Augmentation of Short Segment Fixation for Unstable Burst Fracture in Severe Osteoporosis. JKNS 2008

Kim HS et al. Endoscopic Transforaminal Suprapedicular Approach in High Grade Inferior Migrated Lumbar Disc Herniation. JKNS 2009

Kim HS et al. Minimally Invasive Multi-Level PLIF Using a Percutaneously Inserted Spinal Fixation System. JKNS 2011

Kim HS et al. Comparative study between different PEILD techniques. Pain Physician 2013

PAPERS: MORE THAN 40 PAPERSPAPERS: MORE THAN 40 PAPERS

Korean Neurosurgical Society: Luncheon Seminar: PELD; Benefits and Limitations / WCMISST 2012, Brazil: Minimally invasive TLIF and PLIF using

the Apollon system / WFNS 2013, Korea: Structural Preservation PEID

KNS / WFNS (World Federation of Neurosurgical societies) / NASS / Eurospine / ISAS / World Spine / KOMISS / ACMISST / Asia Spine / WCMISST /

ISMISS TURKEY / IITS / WENMISS

LECTURE & PRESENTATION: MORE THAN 100 TIMESLECTURE & PRESENTATION: MORE THAN 100 TIMES

REFERENCE DOCTOR

To reduce the approach-related morbidity associated with traditional lumbar fusion

Minimal anatomic dissection

Minimal skin incision

Minimal operation time

Minimal blood loss & minimal transfusion

Minimal postoperative pain

Minimal hospital stay period

Better cosmetic benefit

Early ambulation / Recovery

MIS TLIF GOALS OF MISSGOALS OF MISS

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Mini-open Posterior Lumbar Interbody Fusion(PLIF)Mini-open Posterior Lumbar Interbody Fusion(PLIF)

Transforaminal Lumbar Interbody Fusion(TLIF)Transforaminal Lumbar Interbody Fusion(TLIF)

MIS TLIF MISS FUSIONMISS FUSION MIS TLIF MISS FUSIONMISS FUSION

Indirect Decompression

Neural Exposure

Segmental Restoration

Two stage

General Anesthesia

Surgery related InjuryDirect Decompression

One stage

Decompression

Epidural Anesthesia

Segmental Restoration

Posterior Structural Damage

MIS TLIF MISS FUSIONMISS FUSION MIS TLIF PERCUTANEOUS TRANSPEDICULAR SCREWPERCUTANEOUS TRANSPEDICULAR SCREW

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MIS TLIF PERCUTANEOUS TRANSPEDICULAR SCREWPERCUTANEOUS TRANSPEDICULAR SCREW MIS TLIF INDICATIONSINDICATIONS

1. Degenerative disc disease with a specific discogenic pain pattern.

2. Low grade 1 or grade 2 spondylolisthesis.

3. Instability of the anterior column in association with posterior

pathology.

4. Fixation across the lumbosacral junction (lumbar/sacrum) especially with

long segment fusion or when a 360-degree fusion is desired.

5. recurrent disc herniation: Some of the more ideal indications include:

previous decompression for a herniated disc or, previous laminectomy

where the patient presents with one-sided radiculopathy requiring

revision decompression in association with micro-instability,

spondylolisthesis, or degenerative disc disease.

Holly LT, Schwender JD, Rouben DP, Foley KT. Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. Neurosurg Focus. 2006 Mar 15;20(3):E6.

MIS TLIF SURGICAL PROCEDURESURGICAL PROCEDURE

Skin IncisionSub-Dermal Dissection

Skin IncisionSub-Dermal Dissection


RetractorRetractor

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Osteotomy: TLIFOsteotomy: TLIF


Decompression: Uni-LateralDecompression: Uni-Lateral


Decompression: Bi-LateralDecompression: Bi-Lateral


Decompression: Bi-LateralDecompression: Bi-Lateral

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Osteotomy: ELIFOsteotomy: ELIF


Cage Insertion: Uni-Lateral


Cage Insertion: Bi-Lateral


Percutaneous ScrewingSequential Dilation & Rod Compression

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Percutaneous ScrewingPercutaneous Screwing


MIS TLIF SURGICAL PROCEDURESURGICAL PROCEDUREPercutaneous ScrewingPercutaneous Screwing

MIS TLIF RESULTRESULT

Epidural Anesthesia

Operation TimeIntra-operative

Blood Loss

1 level 100 % 1 hr ~ 2 hr 100 ~ 300 ml

2 level 95% 2 hr~ 3 hr 300 ~ 500 ml

3 level 90% 3 hr ~ 4 hr 500 ~ 800 ml

Intra-operativeIntra-operative

Midline Surgical Scars Ambulation Time

1 level 3 ~ 5 Cm 1 ~ 2 days

2 level 4 ~ 7 Cm 1 ~ 3 days

3 level 6 ~ 10 Cm 1 ~ 4 days

Post-operativePost-operative

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MIS TLIF RESULTRESULT MIS TLIF RESULTRESULT

2 years later

MIS TLIF CASESCASES

Minimal Structural Damage Unilateral decompression

Minimal Structural Damage Unilateral decompression

47 year-old / Male

MIS TLIF CASESCASES

74 year-old / Female

Minimal Structural Damage Bilateral decompression

Minimal Structural Damage Bilateral decompression

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MIS TLIF CASESCASES


Minimal Structural Damage Multi-level

Minimal Structural Damage Multi-level

MIS ELIF CASESCASES

55 year-old / Male

Minimal Structural Damage Foraminal approach without any neural violation

Minimal Structural Damage Foraminal approach without any neural violation

MIS ELIF CASESCASES


Minimal Structural Damage Bilateral approach

Minimal Structural Damage Bilateral approach

MIS TLIF CASESCASES

56 year-old / Male

Minimal Structural Damage Revision

Minimal Structural Damage Revision

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MIS FUTURE ENDOSCOPIC DECOMPRESSIONENDOSCOPIC DECOMPRESSION MIS FUTURE ENDOSCOPIC LUMBAR INTERBDOY FUSIONENDOSCOPIC LUMBAR INTERBDOY FUSION

MIS FUTURE ENDOSCOPIC LUMBAR INTERBDOY FUSIONENDOSCOPIC LUMBAR INTERBDOY FUSION MIS FUTURE Fusion 1 Day SurgeryFusion 1 Day Surgery

Symptom duration: 6 years

Immediate Postop.

2 weeks F/U

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INDICATION

1.Degenerative disc disease

2.Spondylolisthesis

3. Instability

4.360-degree fusion

5.Revision surgery that needed stabilization

6.Spinal stenosis that needed stabilization

UNILATERAL APPROACH POSTERIOR LUMBAR INTERBODY FUSIONUNILATERAL APPROACH POSTERIOR LUMBAR INTERBODY FUSION

Thank you !

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