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New developments in Spine Surgery for Low Back Pain
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Jean-Louis.Leflot@mil.be
Surgical Treatmentof Low Back Pain &
SciaticsLEFLOT Jean-Louis
Lieutenant ColonelOrthopaedic Surgeon
Military Hospital Queen Astrid BrusselsBelgian Back Society
10-11 december 2010
Disc Herniation
Disc Herniation
Disc Herniation
Facet joints « Overloading »
Failure of the conservative treatment
• Medical treatment• Physiotherapy• Infiltration « Pain Clinic »
DISCECTOMY
DISCECTOMYFibrosis
DISCECTOMYThinning of the disc
• Recurrence of disc herniation• Foramenal stenosis• Facet joints « overloading »
DIAM
DIAM
Man 42Y
Chronic Low Back Pain and Irritation L4 Left
Intra- and Extraforamenal Disc Herniation
Device Intervertebral for Assisted Motion
6 months after discectomy and DIAM L4L5
No more leg pain and good relief of the lumbagosNormal height of the intervertebral disc
DIAM ou INTRASPINEINDICATIONS
DISCECTOMY
- Massive herniated disc leadingto substantial loss of disc material
- Recurrence of herniated disc
- Herniation of a transitional disc withsacralization of L5
DEGENERATIVE DISC DISEASE
- Topping off above or below the fusedsegment, to support newly created loads.
- Isolated Modic I lesion leading to chroniclow-back pain.
HYPERLORDOSIS
- Facet joints overloading
Disc Arthroplasty
Man 39Y (Infantery)
Chronic Low Back Pain and Sciatic L5 right
Disc Hernia L4L5 rightDiscopathy from levels L3L4, L4L5, L5S1
Severe L4L5 and L5S1
Disc Arthroplasty
ALIF L5S1 + TDA L4L5Only 1 approach (RetroPeritoneal) !
Control after 6 monthsNo more lumbago & sciatic
Disc Arthroplasty
Goals of Lumbar TDA ?
• Pain relief• Improved function• Restoration of the sagittal balance• Increased foramenal height• Avoidance of adjacent level breakdown• Longevity
Disc Arthroplasty
The retroperitonealapproach is very
little dilapidating
•It preserves the lumbar muscles
•It avoids the intraspinal fibrosis
Disc ArthroplastyRetroperitoneal Approach
Disc Arthroplasty
« Minimal invasive surgery »
A very good view of the intervertebral space ispossible with a mini-access (5 cm)
Disc Arthroplasty
NO …
BUT …
Accelerated degenerationof the adjacent segments
Disorder of thesagittal balance ?
Dynamic Instability
Disc degeneration L4L5 (L3L4)
Facet osteoarthritis
Disc protrusion
Spinal and foramenal stenosis
DynamicInstability
HIGH RISK after PLIF !
Hypermobility above fusion !
ALIF is beter than PLIF
Man 32 Y(Infantery)
ALIF is beter than PLIF
ALIFrestore :
• Disc Space & Lumbar Lordosis• Foramenal Height• Facet Decompression
Combined Anterior & Posterior Fusionpermits :
• Circonferential Fusion• No intra-canalaire intrusion• No risk of peri-neural fibrosis
N.B. We can perform a DIAM stabilization above thefusion to avoid the hypermobility
ALIF
AXIALIF
AXIALIF
AXIALIFIndications- Discopathy L5S1
without hernia
- Spondylolisthesis L5S1grade 1
+ Posterior fixation
Jean-Louis.Leflot@mil.be
Conclusion
• Disc Hernia• Disc Height• Foramenal Height• Fibrosis• Sagitall Balance
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