![Page 1: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/1.jpg)
Canero G., MD, Rome (Italy) Rome American Hospital
S. Feliciano Clinic
www.islass.org
![Page 2: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/2.jpg)
Epidemiology
Degenerative Lumbar Spinal Stenosis (DLSS)
Roughly 8% adult population affected by Degenerative Lumbar Spinal Stenosis (DLSS)
- Hillibrand AS, Rand N; Am Acad Orthop Surg – 1999 7(4)
20% of patients with low back pain (LBP) have a DLSS
- Zucherman et al;Spine – 2005; 30 - Boden et al;JBJS – 1990 72A(3) - Long DM et al; J Spine Disorders 1996 9(1)
DLSS Surgery in over 65 yrs old patients increased a lot over the past 20 years
- Katz JN; Spine 1995 20 (24suppl) - Ciol MA et al; J Am Geriatr Soc 1996 44(3) - Andersson Adult Spine GBJ; The 2° ed. 1997
![Page 3: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/3.jpg)
Pathoanatomy
Degenerative changes:
Ligamentum flavum (hypertrophied enfolding posteriorly)
![Page 4: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/4.jpg)
Pathoanatomy
Degenerative changes:
Facet joints (hypertrophied up to facet subluxation of a degenerative
spondylolisthesis)
Disc space (annular bulging contributing to narrowing of the canal)
![Page 5: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/5.jpg)
Pathophysiology
Canal constriction meccanically affects the cauda nerve bundle and the free flow of cerebrospinal fluid around this bundle
In turn the nerve fiber is constricted and changes occur in the pia-arachnoid
By increasing the demand on the cauda (patient walking), because of mechanical constriction and associated ischemia, nutritional needs of the nerve roots cannot be satisfied
( Watanabe and Parke, J. Neurosurg, 1986)
![Page 6: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/6.jpg)
Clinical findings
Clinical evidence of chronic nerve root irritation and compression with: narrowing of the spinal canal or neural foramina (Imaging +++) without vascular impairment to the lower extremities
Insidious symptoms onset of leg and back pain and paresthesias with ambulation, increasing in extension and relieving in flexion
→ Neurogenic Intermittent Claudication (NIC)
(Verbiest H.; JBJS 1954 -36B(2))
![Page 7: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/7.jpg)
NEUROGENIC INTERMITTENT
CLAUDICATION
Pre Post
![Page 8: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/8.jpg)
Current Treatment Options
Conservative management Physical therapy and drugs
Bracing
Epidural Steroids
Decompression surgery Open tecnique
Mininvasive technique (interspinous device)
Decompression surgery is superior to conservative choice in terms of pain relief and patient satisfation but success rate of surgery vary widely
(23 - 100%) !!!!
Turner J et al.; Spine 1992 17:1-8
![Page 9: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/9.jpg)
Interspinous categories
Standalone
Combined with decompression surgery
Combined with fusion
![Page 10: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/10.jpg)
Interspinous Spacers
- Stand Alone Intespinous Decompression
In-Space Aperius
X-Stop (eXtension Stop)
![Page 11: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/11.jpg)
Stand Alone Interspinous
Decompression Systems (IDS)
- Stand Alone Decompression Systems vs Decompression Surgery:
SF 36 Data for Stand Alone: Superior outcomes at 1 yr
Stromqvist et al.; Spine Journal 2004 vol. 4, issue 5, suppl 1, : S58-59
SF 36 profiles before and 1 yr after spinal stenosis surgery: a prospective comparison of two techniques in
two nations
- Stand Alone Decompression Systems vs conservative:
Better symptoms severity score and patient satisfaction at 2yr (ZCQ)
Zucherman et al.; Spine 2005 30:1351-1358
![Page 12: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/12.jpg)
Stand Alone Interspinous
Decompression
What is Stand Alone?
- Only purpose of surgery is to implant the device
- Pain relief and patient satisfaction based only on the
device implanted
![Page 13: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/13.jpg)
Stand Alone Interspinous
Decompression What indications are best for stand alone?
- Foraminal Stenosis
- DLSS with neurogenic intermittent claudication
- Discogenic pain, black discs
- No indication to a fusion surgery
- Failed conservative treatment ( > 6 months)
![Page 14: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/14.jpg)
Standalone
Mini open
Percutaneous
![Page 15: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/15.jpg)
X-Stop eXtension Stop
Mini Open
![Page 16: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/16.jpg)
Surgical Technique
Mini Open
![Page 17: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/17.jpg)
X-Ray
![Page 18: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/18.jpg)
•Canal area: 18%
•Canal diameter: 9%
•Subarticular diameter: 50%
Post op. Pre op.
Biomechanics
![Page 19: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/19.jpg)
• Foramen area: 25%
• Foramen width: 41%
Biomechanics
Post op. Pre op.
![Page 20: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/20.jpg)
Biomecanical transfer of loads
![Page 21: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/21.jpg)
No overincrease pressure adjacent
Discs
![Page 22: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/22.jpg)
Percutaneous stand alone
sistems
INSPACE
APERIUS
![Page 23: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/23.jpg)
- Percutaneous
- Stand Alone Decompression
System
- Unilateral approach
- Respect thoracolumbar
fascia and sovraspinous
ligament
Aperius™ PercLID
![Page 24: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/24.jpg)
Surgical technique
Percutaneous Trocar Insertion
under C-arm A-P / L-L view
![Page 25: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/25.jpg)
TC post op
![Page 26: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/26.jpg)
The System
26
In-Space
Percutaneous
Interspinous Distraction
![Page 27: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/27.jpg)
The implant
Components
1 Core
2 Screw
3 Wires
27
2
3
1
![Page 28: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/28.jpg)
In-situ deployment of the
anchorage
28
When turning the screw
In-Space closes
and the wings are deployed along the spinous processes
![Page 29: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/29.jpg)
In-situ deployment of the
anchorage
29
![Page 30: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/30.jpg)
Technical information
Component Material
1 Core PEEK
2 Wings TAV (Titanium Alloy)
3 Screw TAV
(Titanium Alloy)
30
3
1
2
![Page 31: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/31.jpg)
Technical information PEEK for undisturbed visualisation
TAV to control the correct positioning
of the implant
31
![Page 32: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/32.jpg)
Inspace vs aperius
inspace aperius
Peek
Percutaneous and
miniopen
Possibility to close wings
to remove device
No monouse
instrumentation
access: lateral
Titanium
Percutaneous
No possibility to close
wings to remove device
Monouse instrumentation
Access: posterolateral
![Page 33: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/33.jpg)
Advantages
Postop standing after few hous
Fast functional recovery (no bracing)
Fast return to daily activities
Postop rehabilitation not necessary
Good patient’s satisfaction, compliance
and results if right indications →
Mild to Moderate DLSS
![Page 34: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/34.jpg)
ADVANTAGES: Local Anesthesia
Avoid risks due to general anesthesiological procedures
Pecutaneous Technique
Reduction of operating time (10+/-5 min)
Reduction of risks and complications due to open surgery
(Bigger skin incision, bleeding, bone removal, muscle
damage, Postsurgical scar…)
No sovraspinous ligament removal (in comparison to other
Interspinous Spacers)
Can be used even in spine deformities (scoliosis <25
Cobb angle)
![Page 35: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/35.jpg)
PITFALLS
Device mobilization
Spinosus process fracture
Dural sac tear (avoid in L5-S1)
Very Severe Stenosis (bone spur)
Tethered Cord
Insufficent Decompression
![Page 36: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/36.jpg)
Interspinous Spacers
- Combined with decompression surgery
Coflex (
![Page 37: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/37.jpg)
Indications
STENOSIS
DISCAL HERNIA
LORDOSIS DISORDER
![Page 38: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/38.jpg)
Disc Herniation
Most often encountered at L4-L5
Imaging findings: facets hypertrophy,
slackness of the posterior supra-spinous ligament,
abnormal approximation of the spinous process (kissing spine)
Surgical treatment: Interspinous spacer
with/out Discectomy
![Page 39: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/39.jpg)
Disc herniation
![Page 40: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/40.jpg)
Stenosis
Central, lateral or foraminal stenosis
Surgical treatment : Interspinous spacer with
partial laminectomy, facetectomy and/or
foraminotomy
![Page 41: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/41.jpg)
Stenosis
![Page 42: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/42.jpg)
Stenosis + Static disorder
![Page 43: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/43.jpg)
Ms MOT, 33 years Post-op
Segmental instability
![Page 44: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/44.jpg)
Adjacent to fused level
• Accelerated degeneration of the adjacent segments
• Surgical treatment: topping off above or below the fused segment, to support newly created loads
![Page 45: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/45.jpg)
Interspinous spacer combined with
decompression : advantages Simple and Safe
Good acceptability for surgeons and patients
Dynamic shock absorber allowing optimal mechanical
behavior in compression and flexion
Restorative restores the normal balance to the spine providing
stability and absorbing loads
Mini-invasive
![Page 46: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/46.jpg)
StenoFix
The interspinous
spacer for
after surgical
decompression
![Page 47: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/47.jpg)
The implants
5 sizes, from 8 to 16 mm
Sterile packed
Color coded with the trial
instruments
47
8 10 12 14 16
![Page 48: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/48.jpg)
Anatomical fit
Features Benefits
Cranial radius Fits into the natural concavity of the superior spinous process
Caudal, long, flat surface Enhances the surface of contact with the inferior spinous
process
48
![Page 49: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/49.jpg)
Comparative with Coflex
49
StenoFix Coflex
1. Anatomical fit
StenoFix has through the good anatomical
fit a better surface of contact with the bone
Coflex has in a lot of patients a reduced
point of contact to the cranial spinous
process
![Page 50: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/50.jpg)
StenoFix Coflex
2. Ventral positioning
Stenofix can be pushed more ventrally between
the 2 facets
= better ventral position
Coflex will hit the bony junction
between the laminae and the
spinous processes earlier.
50
10m
m
12
mm
![Page 51: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/51.jpg)
Double implant StenoFix Coflex
3. Two levels implantation
Less wings impingement
The 2 implants can be placed in a good
ventral position.
Wings are not angulated and not staggered
enough.
The second implant cannot reach the same
ventral position as the first inserted implant
51
![Page 52: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/52.jpg)
StenoFix Coflex
4. Ease of use
The larger base of the Stenofix wings allows
an easier insertion between the cranial
spinous process
52
Coflex StenoFix
9mm
7.5mm
![Page 53: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/53.jpg)
StenoFix Coflex
5. Dampening characteristics
Spring designed for a uniform dampening
behavior, independently of where the loads
are transmitted to the implant.
The resulting stiffness of the implant is not
influenced by the implant positioning into
the patient
.
Depending of the anatomical sit of the
Coflex, the body load is transmitted to the
implant at different places from one patient
to the other.
Load transmitted posteriorly implant has
a low stiffness
Load transmitted more ventrally implant
is completely rigid
53
High stiffness Low stiffness Uniform stiffness
![Page 54: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/54.jpg)
X-ray Case Example
![Page 55: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/55.jpg)
Interspinous combined with fusion
primaLock
romeo2pad
axle
aspen
![Page 56: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/56.jpg)
Main features
These devices are ancorate to spinous
processes
All devices have the possibility to fill the
interspinous space with bone to obtain
artrodesis
![Page 57: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/57.jpg)
Surgical technique Romeo pad
Perform a midline approach, resecting the supra-spinous and
interspinous ligaments. Use the process preparer and the
curette to clean the contact surface between implant and bone
on both sides of the spinous processes and between the
spinous processes.
The contact surface between the bone and the implant must
be free of tissue, muscles and ligaments.!
Insert the trial implant in order to determine the
correct size of the device.
![Page 58: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/58.jpg)
Connect the plate with the PEEK cage
without clipping it yet, in order to ensure
maximum space between the plates to
facilitate the insertion of the implant
between the spinous processes.
Connect the implant to the implant holder by
screwing the threaded shaft into the PEEK
cylinder
Use the compression forceps to squeeze the
implant and
fix it on the spinous processes.
The implant has two hollows on each side that
receive
the tips of the tightener to secure the
connection. !
![Page 59: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/59.jpg)
.
Final construct
![Page 60: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/60.jpg)
![Page 61: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/61.jpg)
![Page 62: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/62.jpg)
These devices deliver simplified posterior stabilization and
renewed anatomical alignment for the following seven different
constructs.
Posterior Interlaminar Fusion with the Device
Posterolateral Fusion with the Device
ALIF with the Device
TLIF with Unilateral Pedicle Screws and the Device
TLIF with the Device
Hybrid Constructs/Revision Procedures
Direct Lateral with the Device
![Page 63: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/63.jpg)
Benefits
Minimally invasive fusion device
Provides efficient and optimal placement for secure fixation
Innovative design accommodates wide range of anatomical variation
Integrated bone graft enclosure
![Page 64: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/64.jpg)
Past: Anatomy’s Lesson of Doctor Tulip (Rembrandt, 1632)
Future Focusing: Less is More
![Page 65: Presentazione di PowerPoint DICEMBRE/164… · Degenerative Lumbar Spinal Stenosis ... with/out Discectomy . Disc herniation . ... Ms MOT, 33 years Post-op Segmental instability](https://reader033.vdocuments.site/reader033/viewer/2022053006/5f0a165f7e708231d429f52d/html5/thumbnails/65.jpg)