Coalesce thoracolumbar interbody fusion device and cohere cervical interbody fusion device courtesy of nuvasive, inc. Transforaminal lumbar interbody fusion san antonio, tx. Anatomical considerations for the extreme lateral xlif. Which of these product concepts was a founding principal in nuvasives solutions to minimally invasive spine surgery. Notably, nuvasive is currently leaving no stone unturned to cash in on the rapidlyevolving spine. Pocket mix tumblr amazon wish list aol mail balatarin bibsonomy. Nuvasive extends porous peek interbody to tlif, plif elizabeth hofheinz, m.
The tlif implant is available in a 25mm length x 10mm width footprint, and is provided with and without lateral windows. Avenue t tlif cage surgical technique guide 3 zimmer biomet spine does not practice medicine. 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. Minimally invasive posterior lumbar interbody fusion plif. The goal of a tlif fusion is to reduce back pain and nerve irritation. Nuva, the leader in spine technology innovation, focused on transforming spine surgery with minimally disruptive. All images in this technique guide depict an open tlif procedure for image clarity.
Surgical internship, department of surgery, thomas jefferson university hospital, philadelphia, pennsylvania 20002001. Large bone graft windows are located through the body of the device to allow for. This is the tenth in a series of 10 articles discussing the 31 root operations of icd10pcs. A comparison to anterior lumbar interbody fusion alif and posterior lumbar interbody fusion pliftransforaminal lumbar interbody fusion tlif techniques is.
Transforaminal lumbar interbody fusion tlif is commonly used to treat degenerative pathologies of the lumbar spine. The 18 mm xlif cage with unilateral ps provided greater stability than the 11 mm tlif cage. 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 technique lateral accesssurgical considerations xlif the xlif technique described in this guide utilizes a lateral, retroperitoneal, transpsoas approach to access the intervertebral disc. 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.
A propensitymatched analysis from the national neurosurgical quality and outcomes database registry. In general, surgical options can be classified in two categories taking the transverse process as a reference mobbs et al. 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. Transforaminal lumbar interbody fusion tlif back surgery. Plif posterior lumbar interbody fusion plif is a surgical technique for placing bone graft between adjacent vertebrae interbody. 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. Nuvasive extends porous peek interbody to tlif and plif.
Nuvasive filed an amended counterclaim on september 4, 2009, alleging that nuvasives u. Gus varnavas, md, is a boardcertified, fellowshiptrained neurosurgeon. Only original papers are considered for publication with the understanding that they are contributed solely to spine. The lessdisruptive lateral approach by nuvasive is a breakthrough for spine patients, but it is of particular benefit for active patients who want to return to their active lifestyles more quickly and easily, or those who cannot tolerate a larger, open procedure because of the increased risks of longer anesthesia time, greater blood loss. The distinct difference between a traditional open tlif and a mas tlif,is the surgical approach. Percutaneous and minimally invasive approaches to decompression and arthrodesis of the thoracolumbar spine. Lnk lumbar interbody fusion cage system surgicaltechnique. Nuvasiver announces first patients in japan treated with the xlifr surgical technique.
Mas tlif is an efficient and reproducible technique. Mis spine system adaptable mis solutions for an evolving practice. The fluoroscope should have adequate access to the surgical field for both the lateral and anteroposterior views. Royal oak ibfd system surgical technique transforaminal. Alif, a number of technique tips apply in every interbody fusion procedure. Llif is a minimally invasive surgical method that permits the placement of. Lumbar interbody fusion is a surgical technique that attempts to. Information you read on this website cannot replace the relationship that you have with your healthcare professional.
Spine, depuy synthes spine, nuvasive, orthosurgical. The materials on this website are for your general educational information only. 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. A thinbladed cervical retractor system is used to keep the split longus colli muscle apart in. American association of neurological surgeons, san. Retrograde ejaculation an overview sciencedirect topics.
Gus varnavas, md boardcertified, fellowshiptrained. The xlif procedure is the first clinicallyvalidated lateral approach to the. Using special surgical instruments the surgeon then does the entire tlif procedure through the tube. Xlif surgical technique guide surgical tech classes. Maximum access surgery mas transforaminal lumbar interbody fusion tlif is a surgical procedure that was developed to provide spinal stability and help. Lumbar transforaminal lumbar interbody fusion tlif. 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. Nuvasive has announced the pulse surgical automation platform has received 510k clearance from the us food and drug administration fda. For a complete overview of spinal fusion, including approaches, bone grafting, complications, and rehabilitation, please go to lumbar spinal fusion. 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. 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. Lumbar interbody fusion is a surgical technique that attempts to eliminate instability in the back.
A mas tlif achieves this by using a less invasive approach to fuse one or more vertebrae. Nuvasive s tlx interbody system gets expanded fda approval. Benefit of transforaminal lumbar interbody fusion vs posterolateral spinal fusion in lumbar spine disorders. Impacted cages made of titanium, carbonfiber reinforced or plain peek polymer polyetheretheketone. However, the tlif procedure places a single bone graft between. 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. Faculty profile university of mississippi medical center. Patients undergoing decompression for single level grade 1 ds with lss were enrolled in the openlabel, multicenter, fdaide study with 2.
This procedure should reduce the approachrelated muscle pain often seen in. The precice intramedullary limb lengthening system is an innovative, marketleading solution to help patients with limb length discrepancy lld. The operation is performed under the operating microscope or an endoscope. The launch and updated claims follow the nuvasive september 2017 acquisition of vertera spine, developers of interbody implants for spinal fusion using patented porous. Nuvasive brings porous titanium spine implants to its tlif offerings. Access surgery mas transforaminal lumbar interbody fusion. Nuvasive extends porous peek interbody to tlif, plif. Tlif technique and indication vaccaro et text book in press 1212. Nuvasive portfolio now includes alif retractor platform for. The nerves of the lumbar plexus reside within the psoas, and the technique is dependent upon realtime electromyographic monitoring. Vingan has been an educator and taught other surgeons about his surgical technique. Axial view of cages used in testing coroent, nuvasive, inc, san diego, ca.
A transforaminal lumbar interbody fusion tlif is performed to remove a portion of a disc that is the source of back or leg pain. Please refer to the stryker retractor system surgical technique guides, including luxor, phantom, and. 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. Implant the supplemental fixation according to the recommended surgical technique for the specific system. Minimallyinvasive technique for transforaminal lumbar interbody fusion tlif. James has expertise performing lateral access spine surgery, disc replacement and minimally invasive procedures. Like the plif posterior lumbar interbody fusion procedure, bone graft is used to fuse the spinal vertebrae after the disc is removed.
Varnavas specializes in spine surgery and in particular cervical spine surgery. Axial view of cages used in testing coroent, nuvasive, openi. Sep 30, 2010 a minimally invasive transforaminal lumbar interbody fusion mis tlif has recently been introduced. This technique was best described by ozgur and colleagues 6 using the xlif system nuvasive, san diego, calif. Axial view of cages used in testing coroent, nuvasive, inc, san diego. 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.
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. The remaining steps in this surgical technique are similar in both open and minimally invasive surgical approaches. Mis spine system adaptable mis solutions for an evolving. However, mis tlif is a technically challenging procedure. Art books entertainment film and motion picture magazines music. Chapter 60 percutaneous and minimally invasive approaches to decompression and arthrodesis of the thoracolumbar spine. Shaft removal driver into a standard medtronic quick connect handle. Lateral lumbar interbody fusion sunshine coast xlif. Varnavas relocated his spine practice to anaconda, montana.
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 nuvasive mas maximum access surgery tlif is a minimally invasive back. It can be used to treat a variety of spinal conditions such as. Minimally invasive transforaminal lumbar interbody fusion. Today there is a minimally invasive tlif technique that is proving to be an effective alternative to open fusion surgery. Pdf minimallyinvasive technique for transforaminal lumbar. With recent advances in microscopy, tissue retractors, and. A conventional tlif procedure can now be accomplished. Threaded cylindrical cages made of titanium, cortical allograft donor bone or synthetic bone.
Lumbar fusion surgery is designed to create solid bone between the adjoining vertebra, eliminating any movement between the bones. 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. In fact, tlif is the most common technique for lumbar fusions in the us. Because youve read recent spinal confusion posts, though, you know that i believe in the power of large intervertebral spacers. In honor of international womens day coming up on march 8, were dedicating a special series for some of our female leaders at nuvasive. This is a surgical process called harvesting the bone graft. Maximum access surgery transforaminal lumbar interbody. Vertebral columns, spring 2017 by international society.
Surgical technique most of the equipment and instruments are similar to those used in conventional cervical spine surgery. It treats spinal instability or weakness by uniting the bones. Bone grafts are placed into the interbody space to be fused. Spinal fusion is a procedure to join, or fuse, two or more vertebrae and can be performed in both the inpatient and outpatient settings. Adam lewis of jackson ms is the first surgeon in mississippi to adopt the flxfit 3d expandable cage as his treatment of choice for. 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. This article focuses on just the surgical procedure of lateral lumbar interbody fusion. Transforaminal lumbar interbody fusion tlif tlif is also a spinal fusion procedure approached through the posterior of the spine. Vbt is a promising minimal invasive nonfusion technique enabling. Nuvasiver announces first patients in japan treated with. In the last decade, there have been dramatic developments in both the techniques as well as the tools employed in the delivery. 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. It is the leading subspecialty journal for the treatment of spinal disorders. The range of motion rom differences were first examined within the same group per cage using repeatedmeasures anova, and then compared between cage groups.
Axial view of cages used in testing coroent, nuvasive, inc, san. The current main techniques of posterior lumbar interbody fusion plif surgery all incorporate a supplementary intervertebral implant. 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. Axial view of cages used in testing coroent, nuvasive. It is not meant to replace any personal conversations that you might. First, even when open technique is employed, careful attention to soft tissue handling can help improve posterior rmuscular function and may decrease pain. New techniques and minimally invasive spine surgery eurospine. 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. Eoi, a privately held medical device company focused on developing and commercializing innovative expandable devices for spine surgery, is proud to announce that dr. 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. Nuvasive launches retractor for lateral, supine approaches.
Benefit of transforaminal lumbar interbody fusion vs. Tlif back surgery indications and technique spinehealth. That means that for plif and tlif the surgeon is forced to use very small spacers see figure 3. A novel, minimallyinvasive, the tlif over plif are fewer complications 5, elimi. 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. Bone and tendon graft substitutes and adjuncts medical. Minimally invasive tlif transforaminal lumbar interbody fusion.
It is a global day that celebrates the social, economic, cultural, and political achievements of women all over. Nuvasive expands its advanced materials science portfolio to. Expandable tlif and plif technology surgical technique. Nuvasive specialized orthopedics is a nuvasive division focused on the design and innovation of disruptive orthopedic solutions.
Bigger is better and thus alif is a much more powerful technique for spinal fusion than plif or tlif. A mas tlif achieves this by using a less invasive approach to fuse one or more vertebrae together to reduce their motion. Back pain centers of america launches free e book for patients considering. 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. 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. Nuvasives tlx interbody system gets expanded fda approval. 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. Nvm5 was designed to enable a safer trajectory surgical technique.
Nuvasive to showcase spine precision surgery leading to. In a minimally invasive tlif, the surgeon inserts a small tube through the skin until it rests on the spine. 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. Saint louis university, surgical approaches to the skull base. L5 s1 fusion tlif back surgery video o arm ct vail. Mas plif maximum access surgery the nuvasive maximum access surgery mas plif procedure is a minimally disruptive approach to traditional back surgery. 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. Minimally invasive spine surgery a practical guide to. 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. Surgical implants such as rods and pedicle screws are attached to the vertebrae. The authors performed retrospective analysis about mis tlif using a single interbody cage. Mar 04, 2020 that means that for plif and tlif the surgeon is forced to use very small spacers see figure 3.
This is the condition for which i most commonly book. Mas tlif maximum access surgery mas transforaminal lumbar interbody fusion tlif is a surgical procedure that was developed to provide spinal stability and help reduce pain in the lower back and lower extremities by using a less disruptive surgical procedure. A perioperative cost analysis comparing singlelevel. Nuvasive has received regulatory shonin approval for several. This technique was developed in conjunction with health care professionals. Setup place the patient on a radiolucent operating table in the supine position. Maximum access surgery transforaminal lumbar interbody fusion. As with any evolving surgical discipline, it is difficult to predict the future of the practice and science of spine surgery. What are the two differentiating features of leverage lfs that make our unique technique possible. Spinal fusion such as a tlif is a surgical technique to stabilize the spinal vertebra and the disc or shock absorber between the vertebra. Typically, screws and rods or other types of spinal instrumentation are used to hold the spine in position while the bone heals. Nuvasive is a world leader in minimally invasive, procedurally integrated spine solutions. During a plif posterior lumbar interbody fusion procedure, the damaged disc is removed from between two vertebrae in the lower back the lumbar region. The video also describes tlif back surgery for l5 s1 fusion.