101 PLIF trussed with a titanium intersomatic parallelepipedic cage and a posterior instrumentation. Daniel Gastambide (Centre Tourville, Paris)

Transcription

1 101 PLIF trussed with a titanium intersomatic parallelepipedic cage and a posterior instrumentation Daniel Gastambide (Centre Tourville, Paris)

2 101 PLIF MATERIAL & METHODS Surgical Indications Hyperalgic disabling chronic lombosciaticas resisting for at least 6 months to every non invasive treatment Failures of previous surgical treatments

3 101 PLIF Technique PLIF with a titanium parallelipipedic cage, trussed with posterior arch vertebral fragments autografts Instrumented : pedicular screwed implants and plates posterior and posterolateral grafts (posterior arch bony chips, iliac bone marrow, Hydroxyapatite)

4 101 PLIF

5

6 101 GIA AGE

7 101 PLIF PreOP lumbalgias duration < 1 year 5 to 9 years 1 to 4 years 10 years & more patients treated in a surgical or medical department during previous years ; therapist middle number / patient : 10

8 101 PLIF sex nombre ,2 years 45,6years

9 40 sex, industrial accident, depression femmes 0 not ind. Acc. nor psy ind. Acc. psy depressed

10 PLIF type of work sedentary retired no prof activity heavy number

11 101 PLIF > 36 m 6 to 12 m 2 m zero preop out of work duration 83 patients in activity

12 101 PLIF Lumbalgia < = > radiculalgia or isolated L<R L=R L>R L isolée

13 preop VAS PAIN 101 PLIF Mean 8, VAS 6 VAS 7 VAS 8 VAS 9 VAS 10

14 101 L1 101 PLIF patients L L3 levels with cage 157 instrumented L4 L c L4L5S1 10 c L4L5 2 c L5S1 6 levels

15 3 cages L3L4 1 pseudarthrosis, 2 hddd + disc. hernia 101 PLIF 16 cages L4L5 7 hddd + disc. hernia (4 recurrences) 6 isolated hddd 2 degenerative SPL 1 congenital SPL

16 101 PLIF G I 32 cages L5S1 16 Congenital SPL 15 Hyperalgic DDD 4 isolated 11 hernias (6 primary, 5 recurrent with 1 stenosis) 1 unil. cage on rad. abnormality

17 30 L4L5S1 instrumentations with cages L4L5 et L5S1 101 PLIF 20 Hyperalgic DDD + DH of which: 7 recent 7 recurrent 6 with stenosis 8 Isolated H DDD 2 Cong. SPL L5S1

18 10 cages on L4L5 level 4 HDDD + recent hernia 1 isolated 3 with stenosis 4 isolated HDDD 1 Degenerative L4L5 SPL 1 unilateral cage 2 cages on L5S1 level 1 pseudarthrosis on prev. a. 1 Congenital SPL L5S PLIF instrumentations L4L5S1 with cages at only one level

19 101 PLIF 6 instrumentations 3 last levels 2 cages on L3L4 1 for degenerative SPL, 1 hddd + DH 1 cages on L4L5 for degenerative SPL 1 cages on L3L4 + L4L5 (hddd + DH) 2 cages on L4L5 + L5S1 1 pseudarthrosis, 1 stenosis + hddd + dh

20 101 PLIF 2 suspended levels (cage + instrumentation) 1 L1L2 + L2L3 (hddd + DH) 1 L2L3 + L3L4 (hddd + DH)

21 101 PLIF Immediate complications (101 patients) 2 compressive post-op hematomas ; urgent reoperation ; no sequel 2 dural tears on scarred tissues, secondary reopened, reoperated 1 acute tubulonephritis

22 101 PLIF Secondary complications (101 patients) 2 cage mobilisations 1 posterior, reop at 8 months with higher cages 1 impacted in L5 body, reop by cages ablation & autografts 1 infected hematoma; reop on 21st day 1 pulmonary embolism + superficial infection (diabetes mellitus) 2 extensor proprius paresia, 1 transitory, 1 definitive

23 46 good Résults Stauffer & Coventry 64 PATIENTS MEAN FOLLOW UP 24 MONTHS 89.1% (12 to 60) improved 11 fair 7 poor

24 64 PLIF mean follow up 2 years STAUFFER & COVENTRY: 46 good PROLO: 25 excellent, 21 good VAS: 8.48 à 1.79 mean improvement rate 79.5% BEAUJON: 6.24 à 15.9 mean improvement rate 71%

25 64 PLIF mean follow up 2 years 46 good results 7 industrial accidents (6 heavy", 1 sed.) 2 are working again after 1 year 2 invalidity pension 2 associated medical diseases (1 parkinson,1 tetany) 1 early retired 39 non industrial accidents

26 64 PLIF mean follow up 2 years 39 good results non industrial accidents 3 retired 4 no professional activity 32 with professional activity (29 heavy" + 3 sedentary) 27 back to work at a mean of 9 months 2 unemployed 1 early retired 1 professional retraining 1 other disease (cauda equina neurinoma appeared at 8 months)

27 64 PLIF mean follow up 2 years STAUFFER & COVENTRY 11 fair results VAS mean improvement rate 50% (22 to 89%) BEAUJON m. improvement rate 41% (20 to 73%) 6 heavy" : 5 no capacity for sedentary work, invalidity pension 1 professional retraining 2 "sedentary" back to work at 3 months 1 no professional activity 2 regrading: 1 heavy et 1 sedentary

28 64 PLIF mean follow up 2 years STAUFFER & COVENTRY 7 poor 2 radicular abnormalities 1 cage only on last hinge level 1 congenital spondylolisthésis not cause of symptoms 4 Hyperalgic Degenerative Disc Disease 2 industrial acc. with 1 rec. DH 1 pseudarthrose 1 primary DH 1 isolated DDD

29 64 PLIF mean follow up 2 years 101 PLIF On 64 patients mean followup ~ 2 years VAS mean improvement rate 75%, Beaujon mean improvement rate 62%

30 Without previous OP 94% success With previous OP 78% success Previous OP = lost of 16 pts

31 64 PLIF mean follow up 2 years Radiological results good intervertebral fusion except 2 cases with a clear border about cage anterior part

32 DISCUSSION Posterior approach: only in 1 time Cages: immediate good result Titanium: no break, good acceptance Screw + post. plates: mechanical security

33 Fusion in industrial accident? 10 patients: 7 good, 1 fair, 2 poor no significant difference with the rest of the series 64 PLIF mean follow up 2 years Fusion in depressed patients? 13 "psy" 6 good, 5 fair, 2 poor Results 10 Industrial accidents Good Fair Poor Results 13 depressed patients 6 4 Cong. SPL L5S1 better? < 35 years, 6 good results on 6 patients > 40 years 4 good on 7, 2 fair, 1 poor Good Fair Poor Results 13 Cong. SPL Good Fair Poor

34 Indications After 6 months of medical treatment failure Only one level if possible if not 2 last levels Other choice rare

35 101 PLIF CONCLUSION technique of the future 94% success virgin spine