129 - Single Side Lateral Mis Approach - 360 Fusion...

#129 Single Side Lateral Mis Approach - 360 Fusion

MIS Techniques and Outcomes

Poster Presented by: J.G.D.P.V Wanderley

Author(s):

J.G.D.P.V. Wanderley (1)
F. Nigri (1)
V. Bessa (1)
G. Gobbi (1)

(1) Rio de Janeiro University, Neurosurgery, Rio de Janeiro, Brazil

Abstract

Purpose: The lateral approach for lumbar fusion is becoming more popular in the last 5 years, having its big advantages in avoiding great vessels injury, ALL preservation and faster recovery.

New clinical studies are proving the necessity to add a posterior stabilization combined with the lateral cage, to avoid residual back pain and also subsidence. There are several posterior stabilization systems available.

The goal of this paper is to show a new option, keeping the patient in the lateral position and promoting a unilateral interfacet fusion and a contralateral percutaneous translaminar facet screw fixation.

Material and Methods: From January 2012 to January 2013, 10 patients underwent lateral fusion due to DDD in one or two levels without several instability or sagital inbalance.

The surgical technique performed was a lateral fusion with Xlif combined with a interfacet fusion in the side up through a paraspinal incision at the desired level, opening the facet joint and removing the cartilage followed by a bone grafting or the placement of a interfacet bioceramic spacer. Through a stab wound based on a pre op planning a translaminar facet screw was placed for the fixation of the facet joints in the side down.

8 patients for a single level and 2 patientes for a two levels procedure.

2 patients for a revision surgery due to adjacente level disease and a subsidence after a 2 levels Xlif.

Results:

The follow up average was 6 months.

The VAS average pre op was 7 and post op 2.

The ODI average pre op was 60 and post op 32.

The hospital stay average was 36 hours and the blood loss around 100 ml.

No new complains added regarding the posterior approach and no new neurological deficit.

Infection rate zero.

Conclusion: The lateral approach for interbody fusion is a very elegant procedure and the posterior stabilization system has to join it.

Pedicle screws should be indicated only for deformities, multiple levels and severe instability.

The Single Side Lateral MIS Approach for a 360 fusion is a new, safe and reproducible method to be combined with lateral fusion techniques, addressing lumbar DDD from 1 to 2 levels in all lumbar spine segments, benefiting mainly elderly patients with comorbidities and poor bone quality.