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Introduction: PLIF
Posterior lumbar interbody fusion (PLIF) is a surgical technique for placing
bone graft between adjacent vertebrae (interbody). Typically, screws and rods
or other types of spinal instrumentation are used to hold the spine in position
while the bone heals. Indications for this procedure may include pain and spinal
instability resulting from spondylolisthesis, degenerative disc disease, or
when a discectomy is performed to relieve nerve compression and the patient
has associated mechanical low back pain.
Spinal fusion uses bone graft to promote specific vertebrae to grow or fuse
together into a solid and stable construct. Instrumentation, also called internal
fixation, incorporates the use of rods, screws, cages, and other types of medical
hardware to provide immediate stability to the spine and facilitate fusion.
Minimal Access Spinal Technologies
Today, spinal surgery has advanced to a new level that utilizes Minimal Access
Spinal Technologies (MAST). These technologies replace traditional open surgical
procedures with innovative minimally invasive techniques and tools. To grasp
the importance and benefits of minimally invasive spine surgery, review the
following comparison:
Open Approach
A longer incision along the middle of the back is necessary. Large bands of
muscle tissue are stripped from the underlying spinal elements including the
spinous process, lamina, and facets. These tissues are pulled aside (retracted)
during surgery to provide the surgeon a good view of the spine and room for
performing the procedure. During complex spine surgeries, these surrounding
tissues (paraspinous) may need to be retracted for long periods of time. Stripping
the paraspinous tissues and retracting them can contribute to post-operative
pain and prolong the patient's recovery.
Minimally Invasive Approach
In minimally invasive procedures, the surgical incisions are small, there
is no need (or minimal need) for muscle stripping, there is less tissue retraction,
and blood loss is minimized. Special surgical tools allow the surgeon to achieve
the same goals and objectives as the open surgery while minimizing cutting
and retracting of the paraspinous muscles. Therefore, tissue trauma (injury)
and post-operative pain are reduced, hospital stays are shorter, and patients
can recover more quickly.
Open PLIF Procedure
A typical PLIF procedure involves an open incision (approximately 6 inches long)
in the middle of the lower back followed by stripping the paraspinous muscles
away from the spine. Bone removal (laminectomy) and lumbar discectomy are performed
to remove pressure from affected spinal nerve roots. When the offending disc
is removed an empty space is left between the upper and lower vertebrae (interbody).
This is filled with bone graft. Implants made of bone, metal, or other materials
are typically inserted into the interbody space. Finally, pedicle screws are
placed into the upper and lower vertebrae and connected with rods or plates.
MAST PLIF Procedure
Now spine surgeons can combine three innovative spinal surgical "systems" with
Minimal Access Spinal Technologies (MAST). The combination of these systems
allows a PLIF to be performed through two one-inch incisions on either side
of the low back. The paraspinous muscles do not need to be stripped from the
spine. The spine surgeon can perform bone removal, a discectomy, an interbody
fusion, and pedicle screw insertion through the same small incisions!
METRx™ is a microsurgical system that uses tubes inserted via small
skin incisions to work through the normal tissue spaces that separate muscle
fibers. These tubes are made to dilate the tissue spaces sequentially, thereby
eliminating or minimizing the need for muscle stripping or cutting. The PLIF
procedural steps of bone removal, discectomy, and bone graft / interbody implant
placement are carried out through the METRx tubes.
TANGENT™ is an implant and instrument system used to prepare the interbody
space for insertion of precision-machined wedges of cortical bone (bone graft
implants).
CD HORIZON® SEXTANT™ is a "percutaneous"
(through the skin) pedicle screw and rod insertion system. It enables the
surgeon to precisely implant the screws and rods in a minimally invasive fashion.
Once the METRx tubes have been removed, the SEXTANT™ screws are placed through
the same small (one-inch) incisions. The rods are percutaneously inserted
through tiny openings (approximately one-fourth of an inch long) in the skin.
This system helps to immobilize the spine (internal fixation) so the bone
grafts can heal and fuse the vertebrae together.
Conclusion
Advancements in spine surgery continue to evolve, providing surgeons with better
tools and techniques to treat patients with spinal disorders. We can only expect
further improvements as spine specialists continue to adopt and develop emerging
technologies and integrate them into their practices.
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