However, mis tlif is a technically challenging procedure. Back pain centers of america launches free e book for patients considering. What are the two differentiating features of leverage lfs that make our unique technique possible. Gus varnavas, md, is a boardcertified, fellowshiptrained neurosurgeon. Spinal fusion such as a tlif is a surgical technique to stabilize the spinal vertebra and the disc or shock absorber between the vertebra. Although a first detailed description of the tlif technique was given by harms and jeszenszky 14 as early as 1998 the number of published papers concerning. Which of these product concepts was a founding principal in nuvasives solutions to minimally invasive spine surgery.
This technique was best described by ozgur and colleagues 6 using the xlif system nuvasive, san diego, calif. Expandable tlif and plif technology surgical technique. Royal oak ibfd system surgical technique transforaminal. In general, surgical options can be classified in two categories taking the transverse process as a reference mobbs et al. Surgical implants such as rods and pedicle screws are attached to the vertebrae. Transforaminal lumbar interbody fusion tlif tlif is also a spinal fusion procedure approached through the posterior of the spine. Minimally invasive posterior lumbar interbody fusion plif. Axial view of cages used in testing coroent, nuvasive, openi. Axial view of cages used in testing coroent, nuvasive. Axial view of cages used in testing coroent, nuvasive, inc, san diego. This technique was developed in conjunction with health care professionals. This is the tenth in a series of 10 articles discussing the 31 root operations of icd10pcs. Nuva, the leader in spine technology innovation, focused on transforming spine surgery with minimally disruptive.
Minimally invasive transforaminal lumbar interbody fusion. Vertebral columns, spring 2017 by international society. A thinbladed cervical retractor system is used to keep the split longus colli muscle apart in. The 18 mm xlif cage with unilateral ps provided greater stability than the 11 mm tlif cage. Nuvasive to showcase spine precision surgery leading to. Nuvasives tlx interbody system gets expanded fda approval. A comparison to anterior lumbar interbody fusion alif and posterior lumbar interbody fusion pliftransforaminal lumbar interbody fusion tlif techniques is. The remaining steps in this surgical technique are similar in both open and minimally invasive surgical approaches. Nuvasive to participate in investor events in march 2017 read more nuvasive reports fourth quarter and full year 2016 financial results read more nuvasive to present at leerink partners 6th annual global healthcare conference 2017 read more nuvasive announces conference call and webcast of fourth quarter 2016 results read more. Minimallyinvasive technique for transforaminal lumbar interbody fusion tlif. Retrograde ejaculation an overview sciencedirect topics.
Axial view of cages used in testing coroent, nuvasive, inc, san diego, ca. Lateral lumbar interbody fusion sunshine coast xlif. Xlif surgical technique guide surgical tech classes. Large bone graft windows are located through the body of the device to allow for. Nuvasiver announces first patients in japan treated with. A conventional tlif procedure can now be accomplished. Nuvasive is a world leader in minimally invasive, procedurally integrated spine solutions. Please refer to the stryker retractor system surgical technique guides, including luxor, phantom, and. A novel, minimallyinvasive, the tlif over plif are fewer complications 5, elimi. Art books entertainment film and motion picture magazines music.
The xlif procedure is the first clinicallyvalidated lateral approach to the. With the launch of its latest spine implant, nuvasive has expanded its porous titanium portfolio to all transforaminal lumbar interbody fusion surgeries, or tlif procedures. As with any evolving surgical discipline, it is difficult to predict the future of the practice and science of spine surgery. Avenue t tlif cage surgical technique guide 3 zimmer biomet spine does not practice medicine.
Because youve read recent spinal confusion posts, though, you know that i believe in the power of large intervertebral spacers. Bone and tendon graft substitutes and adjuncts medical. Minimally invasive spine surgery a practical guide to. Transforaminal lumbar interbody fusion san antonio, tx.
Spinal fusion is a procedure to join, or fuse, two or more vertebrae and can be performed in both the inpatient and outpatient settings. Tlif technique and indication vaccaro et text book in press 1212. A perioperative cost analysis comparing singlelevel. The purpose of this study is to assess the operative safety and shortterm outcomes of ptb compared to transforaminal lumbar interbody fusion tlif for patients with ds and lss. Surgical technique fluoroscopic planning use ap and lateral fl uoroscopy to identify and target the appropriate levels ensure that the carm is positioned correctly for each. Vingan has been an educator and taught other surgeons about his surgical technique. Transforaminal lumbar interbody fusion tlif back surgery.
From complex spinal deformity to degenerative spinal conditions, nuvasive is transforming spine surgery with innovative technologies designed to deliver reproducible and clinically proven surgical outcomes. First, even when open technique is employed, careful attention to soft tissue handling can help improve posterior rmuscular function and may decrease pain. Setup place the patient on a radiolucent operating table in the supine position. Using special surgical instruments the surgeon then does the entire tlif procedure through the tube. It is the leading subspecialty journal for the treatment of spinal disorders.
Nuvasive specialized orthopedics is a nuvasive division focused on the design and innovation of disruptive orthopedic solutions. It can be used to treat a variety of spinal conditions such as. Mas plif maximum access surgery the nuvasive maximum access surgery mas plif procedure is a minimally disruptive approach to traditional back surgery. The fluoroscope should have adequate access to the surgical field for both the lateral and anteroposterior views. Bigger is better and thus alif is a much more powerful technique for spinal fusion than plif or tlif. In fact, tlif is the most common technique for lumbar fusions in the us. The tlif implant consists of banana shaped blocks in a parallel configuration of various heights 8mm 16mm, in 2mm increments. Nuvasive filed an amended counterclaim on september 4, 2009, alleging that nuvasives u. Maximum access surgery transforaminal lumbar interbody fusion. Lumbar interbody fusion is a surgical technique that attempts to eliminate instability in the back. L5 s1 fusion tlif back surgery video o arm ct vail. Minimally invasive tlif transforaminal lumbar interbody fusion. Nuvasive extends porous peek interbody to tlif and plif.
The materials on this website are for your general educational information only. Mis spine system adaptable mis solutions for an evolving. Nuvasive launches retractor for lateral, supine approaches. Surgical technique tlif overview once the tube is placed in the proper position and with appropriate trajectory for a tlif, begin to remove residual soft tissue in a standard manner utilizing electrocautery and other standard instruments. The nerves of the lumbar plexus reside within the psoas, and the technique is dependent upon realtime electromyographic monitoring. This is a surgical process called harvesting the bone graft. Typically, screws and rods or other types of spinal instrumentation are used to hold the spine in position while the bone heals. Mas tlif is an efficient and reproducible technique. Saint louis university, surgical approaches to the skull base. Nuvasive brings porous titanium spine implants to its tlif offerings. Lumbar transforaminal lumbar interbody fusion tlif. New techniques and minimally invasive spine surgery eurospine. During a plif posterior lumbar interbody fusion procedure, the damaged disc is removed from between two vertebrae in the lower back the lumbar region.
Nuvasive portfolio now includes alif retractor platform for. Pdf minimallyinvasive technique for transforaminal lumbar. That means that for plif and tlif the surgeon is forced to use very small spacers see figure 3. Anatomical considerations for the extreme lateral xlif. Surgical technique most of the equipment and instruments are similar to those used in conventional cervical spine surgery. The mis tlif is an example in the spine, whereby the decompression and fusion and instrumentation are quite similar to the open procedure, but through a.
Implant the supplemental fixation according to the recommended surgical technique for the specific system. Posterior lumbar interbody fusion plif is a surgical technique that attempts to eliminate instability in the back and pain in the lower back and lower extremities. The video also describes tlif back surgery for l5 s1 fusion. A maximum access surgery posterior lumbar interbody fusion mas plif achieves this by using a less disruptive approach to decompress nerve roots and fuse one or more vertebrae together to reduce their motion. Lumbar fusion surgery is designed to create solid bone between the adjoining vertebra, eliminating any movement between the bones. The operation is performed under the operating microscope or an endoscope. The authors performed retrospective analysis about mis tlif using a single interbody cage. The tlif implant is available in a 25mm length x 10mm width footprint, and is provided with and without lateral windows. Threaded cylindrical cages made of titanium, cortical allograft donor bone or synthetic bone. In honor of international womens day coming up on march 8, were dedicating a special series for some of our female leaders at nuvasive.
Mis spine system adaptable mis solutions for an evolving practice. Benefit of transforaminal lumbar interbody fusion vs posterolateral spinal fusion in lumbar spine disorders. Extreme lateral interbody fusion xlif is a relatively new technique whereby access to the disc space is achieved through a minimally invasive lateral, retroperitoneal, transpsoas approach. Only original papers are considered for publication with the understanding that they are contributed solely to spine. In a mas tlif procedure, rather than starting from the center of the back and spreading the muscles outward, the surgical approach involves bluntly splitting the muscles on one side of the back to directly access the surgical site. The key feature of the technique is the ability to rest the interbody spacer along the strongest portion of the vertebra endplate, namely, the cortical rim or apophyseal ring. Nvm5 was designed to enable a safer trajectory surgical technique.
Varnavas relocated his spine practice to anaconda, montana. Maximum access surgery mas transforaminal lumbar interbody fusion tlif is a surgical procedure that was developed to provide spinal stability and help. Patients undergoing decompression for single level grade 1 ds with lss were enrolled in the openlabel, multicenter, fdaide study with 2. Surgical technique fluoroscopic planning use ap and lateral fl uoroscopy to identify and target the appropriate levels ensure that the carm is positioned correctly for each targeted level by adjusting the position of the carm until both endplates are parallel and the spinous process is equidistant from the center of each pedicle. Research in orthopaedic spine surgery performing a retrospective analysis of the effects of surgical treatment of spine related thoracic pain syndrome with james zucherman, md and ken hsu, md. American association of neurological surgeons, san. Nuvasive announced on 4 january the launch of the companys coalesce thoracolumbar interbody fusion device as well as fda 510k clearance for expanded indications of its cohere cervical interbody fusion device. Transforaminal lumbar interbody fusion tlif is commonly used to treat degenerative pathologies of the lumbar spine. Mar 04, 2020 that means that for plif and tlif the surgeon is forced to use very small spacers see figure 3. Adam lewis of jackson ms is the first surgeon in mississippi to adopt the flxfit 3d expandable cage as his treatment of choice for. Jan 26, 2005 the unilateral transforaminal lumbar interbody fusion tlif represents an alternative surgical technique avoiding both the anterior approach and the approach through the spinal canal. Shaft removal driver into a standard medtronic quick connect handle.
Vbt is a promising minimal invasive nonfusion technique enabling. The distinct difference between a traditional open tlif and a mas tlif,is the surgical approach. Direct lateral interbody fusion transpsoas approach dlif surgical technique instrument set 2 preoperative planning 7 nimeclipse spinal system needle electrode placement 8 patient positioning 10 localization 12 dissection to the psoas neuromonitoring through the psoas 14 dilation 16 retractor placement 16 disc preparation 19 trialing 23. Maximum access surgery transforaminal lumbar interbody. A transforaminal lumbar interbody fusion tlif is performed to remove a portion of a disc that is the source of back or leg pain. The minimally invasive transforaminal lumbar interbody fusion is a surgical technique which allows the surgeon to achieve appropriate neural decompression and also provides rigid stability to allow for fusion. The range of motion rom differences were first examined within the same group per cage using repeatedmeasures anova, and then compared between cage groups. Gus varnavas, md boardcertified, fellowshiptrained. Eoi, a privately held medical device company focused on developing and commercializing innovative expandable devices for spine surgery, is proud to announce that dr. However, the tlif procedure places a single bone graft between. Llif is a minimally invasive surgical method that permits the placement of.
Impacted cages made of titanium, carbonfiber reinforced or plain peek polymer polyetheretheketone. Notably, nuvasive is currently leaving no stone unturned to cash in on the rapidlyevolving spine. Chapter 60 percutaneous and minimally invasive approaches to decompression and arthrodesis of the thoracolumbar spine. With recent advances in microscopy, tissue retractors, and. This procedure should reduce the approachrelated muscle pain often seen in.
Nuvasive has received regulatory shonin approval for several. Access surgery mas transforaminal lumbar interbody fusion. In a minimally invasive tlif, the surgeon inserts a small tube through the skin until it rests on the spine. For a complete overview of spinal fusion, including approaches, bone grafting, complications, and rehabilitation, please go to lumbar spinal fusion.
Nuvasive n developing creative solutions for safe reproducible spine surgery we are a medical device company focused on the design, development, and marketing of products for the surgical treatment of spine disorders. A mas tlif achieves this by using a less invasive approach to fuse one or more vertebrae together to reduce their motion. Alif, a number of technique tips apply in every interbody fusion procedure. Nuvasive extends porous peek interbody to tlif, plif. A mas tlif achieves this by using a less invasive approach to fuse one or more vertebrae. Nuvasive expands its advanced materials science portfolio to. Sep 30, 2010 a minimally invasive transforaminal lumbar interbody fusion mis tlif has recently been introduced. All images in this technique guide depict an open tlif procedure for image clarity. Surgical technique lateral accesssurgical considerations xlif the xlif technique described in this guide utilizes a lateral, retroperitoneal, transpsoas approach to access the intervertebral disc. This is the condition for which i most commonly book. The extreme lateral interbody fusion xlif method is a minimal invasive technique and a valuable alternative to the wellknown traditional standard techniques tlif, alif, plif for the operative. Nuvasiver announces first patients in japan treated with the xlifr surgical technique.
The launch and updated claims follow the nuvasive september 2017 acquisition of vertera spine, developers of interbody implants for spinal fusion using patented porous. The current main techniques of posterior lumbar interbody fusion plif surgery all incorporate a supplementary intervertebral implant. Plif posterior lumbar interbody fusion plif is a surgical technique for placing bone graft between adjacent vertebrae interbody. Nuvasive has announced the pulse surgical automation platform has received 510k clearance from the us food and drug administration fda. Varnavas specializes in spine surgery and in particular cervical spine surgery. It treats spinal instability or weakness by uniting the bones. James has expertise performing lateral access spine surgery, disc replacement and minimally invasive procedures.
Tlif back surgery indications and technique spinehealth. Pliftlif with posterolateral fusion and instrumentation procedure description code modifier comments arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy andor discectomy sufficient to prepare interspace other than for decompression, single interspace and segment. It is not meant to replace any personal conversations that you might. Axial view of cages used in testing coroent, nuvasive, inc, san.
The nuvasive mas maximum access surgery tlif is a minimally invasive back. This article focuses on just the surgical procedure of lateral lumbar interbody fusion. Percutaneous and minimally invasive approaches to decompression and arthrodesis of the thoracolumbar spine. It is a global day that celebrates the social, economic, cultural, and political achievements of women all over. In the last decade, there have been dramatic developments in both the techniques as well as the tools employed in the delivery. The goal of a tlif fusion is to reduce back pain and nerve irritation. A propensitymatched analysis from the national neurosurgical quality and outcomes database registry. Information you read on this website cannot replace the relationship that you have with your healthcare professional. Nuvasive s tlx interbody system gets expanded fda approval. The precice intramedullary limb lengthening system is an innovative, marketleading solution to help patients with limb length discrepancy lld. Traditionally, tlif procedures have been performed via an open approach involving retraction of the paraspinal muscles from the midline for the duration of the procedure.
Anderanin, cpc,cpci,cosc 2 spine anatomy 7 cervical neck vertebrae, 12 thoracic chest vertebrae, 5 lumbar back vertebrae, and 5 fused vertebra that make up the sacrum 4 fused vertebra that make up the coccyx. Like the plif posterior lumbar interbody fusion procedure, bone graft is used to fuse the spinal vertebrae after the disc is removed. May 26, 2016 what is the mas tlif the maximum access surgery transforaminal lumbar interbody fusion mas tlif procedure is a technique that attempts to eliminate instability in your back through a less invasive approach to fuse one or more vertebrae together to reduce their motion. Benefit of transforaminal lumbar interbody fusion vs. Bone grafts are placed into the interbody space to be fused. The 26 mm xlif cage provided greater stability than the 18 mm xlif cage with unilateral ps and 11 mm tlif cage with bilateral ps. Nuvasive extends porous peek interbody to tlif, plif elizabeth hofheinz, m. During the spinal fusion surgery, a separate surgical procedure is conducted to remove bone from another part of the patients body and place it in the area of the spine to be fused. Surgical internship, department of surgery, thomas jefferson university hospital, philadelphia, pennsylvania 20002001. Coalesce thoracolumbar interbody fusion device and cohere cervical interbody fusion device courtesy of nuvasive, inc. Lumbar interbody fusion is a surgical technique that attempts to. Spine, depuy synthes spine, nuvasive, orthosurgical.