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Degenerative Spondylolisthesis PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Degenerative Spondylolisthesis: The Best Fixation is an Open Fusion with Hardware Options” by Colin B. Harris, MD.

This medical PowerPoint presentation is about degenerative spondylolisthesis, a condition where one vertebra slips forward over the vertebra below it due to degeneration of the spinal joints and discs. Open fusion with hardware options can be an effective fixation method for treating this condition, but it is not always the best option for every patient.

Open fusion with hardware options involves surgically fusing the affected vertebrae together using bone grafts and metal hardware such as screws and rods to provide stability and support. The procedure can help relieve pain, improve spinal alignment, and prevent further slippage of the affected vertebra.

However, the decision to undergo open fusion with hardware options should be made after a thorough evaluation of the patients condition, overall health, and lifestyle factors. Factors such as the degree of slippage, the presence of other spinal conditions, and the patients age and activity level can all influence the best treatment approach.

Other treatment options for degenerative spondylolisthesis include physical therapy, medication, and minimally invasive procedures such as spinal injections or decompression surgery. These may be more appropriate for certain patients depending on the severity of their symptoms and the extent of their condition.

In conclusion, open fusion with hardware options can be an effective fixation method for treating degenerative spondylolisthesis, but it is not always the best option for every patient. A thorough evaluation of the patients condition and individual needs is necessary to determine the best treatment approach.

Tags : Degenerative Spondylolisthesis, degeneration of the spinal joints and discs, Orthopaedic Surgery, Orthopaedic Surgery PowerPoint presentation

Published on : Jun 23, 2023 | Views : 915 | Downloads : 3

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Slide 1-

Degenerative Spondylolisthesis:The Best Fixation is an Open Fusion with Hardware Options Colin B. Harris, MDAssistant Professor Department of Orthopaedics Rutgers – New Jersey Medical School Newark, NJ
Slide 2-

Disclosures Globus, Inc. – Consulting, teaching
Slide 3-

Degenerative Spondylolisthesis Common in older population
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Degenerative Spondylolisthesis Common in older population “Source” of LBP
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Degenerative Spondylolisthesis Common in older population “Source” of LBP +/- Radiculopathy +/- Neurogenic claudication
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Degenerative Spondylolisthesis Common in older population “Source” of LBP +/- Radiculopathy +/- Neurogenic claudication Usually L4-L5 > L3-L4 Conservative treatment 3-6 mo
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ALIF TLIF Laminectomy Laminectomy + posterior fusion
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To simplify: GOALS OF SURGERY Thorough decompression to address leg pain and neurogenic claudication Stable fusion to prevent slip progression +/- improve lower back pain
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To simplify: GOALS OF SURGERY Thorough decompression to address leg pain and neurogenic claudication Stable fusion to prevent slip progression +/- improve lower back pain Minimize cost and risk of complications
Slide 11-

Why operate? “Think Nerve”
Slide 12-

Why operate? “Successful surgical management of isolated lower back pain for degenerative conditions is a gamble at best”
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Laminectomy without fusion Reasonable for elderly / low functioning, “stable” slip Not for young & active Risk recurrent back/leg pain Inferior outcomes vs laminectomy and fusion Herkowitz and Kurz 1991 Herkowitz H, Kurz L. JBJS Am 1991;73(6):802-8.
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Decompression alone?
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Decompression alone?
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Decompression alone?
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MIS TLIF? Learning curve Posterolateral fusion lacking Long-term outcomes no better than open Maybe: higher neurologic injury / CSF leak
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“Trust me, I’m a doctor…”
Slide 19-

“Trust me, I’m a doctor…”
Slide 20-

“Trust me, I’m a doctor…”
Slide 21-

“Trust me, I’m a doctor…”
Slide 22-

ALIF / OLIF ? High fusion rate Large graft Great operation
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ALIF / OLIF ? However… Vascular injury 1-5% Retrograde ejaculation Revision difficult Not easy at L4-L5
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I’m a doctor too! Trust me…
Slide 25-

I’m a doctor too! Trust me…
Slide 26-

I’m a doctor too! Trust me…
Slide 27-

I’m a doctor too! Trust me…
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Open posterior decompression and fusion Withstood test of time Significant benefits Allows thorough decompression Full exposure to posterolateral fusion bed Good long term outcomes Avoid morbidity of anterior / lateral approaches
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76 patients non-instrumented vs instrumented single level lami and fusion for DS 2 year follow up Instrumented group 82% fused (vs 45%) No significant difference in clinical outcomes
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Prospective, randomized study n=47 Decompression + fusion with iliac crest autograft (no instrumentation) Avg. F/U = 7 years, 8 months Excellent to good clinical outcome 86% with solid fusion vs. 56% pseudoarthrosis Conclusion: Patients with solid fusion do better
Slide 33-

What do we know? Patients with solid fusion do better
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What do we know? Patients with solid fusion do better Instrumentation improves fusion rates
Slide 35-

What do we know? Patients with solid fusion do better Instrumentation improves fusion rates Addition of instrumentation BENEFICIAL despite difficulty proving better outcomes in high quality studies
Slide 36-

What are our options Traditional pedicle screws Interspinous devices Cortical screw technique
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Open pedicle screw technique Gold standard Safe Familiar to most surgeons Cons Need for larger soft tissue dissection Risk of nerve injury / screw malposition Add operative time and blood loss
Slide 38-

Open pedicle screw technique Gold standard Safe Familiar to most surgeons Cons Need for larger soft tissue dissection Risk of nerve injury / screw malposition Suboptimal in osteopenic bone
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https://www2.aofoundation.org/wps/portal/
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https://www2.aofoundation.org/wps/portal/
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https://www2.aofoundation.org/wps/portal/
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Pearls Scrutinize axial cuts MRI/CT preop Resect inferolateral corner suprajacent facet Undertap by 1-2mm Avoid burying screw head in facet
Slide 43-

Cortical Screw Technique More medial starting point 30% greater pullout strength Less soft tissue dissection Ideal levels L3 – L4 – L5 (not for S1) Tortolani, Stroh JAAOS 24(11):755-61, 2016
Slide 44-

Cortical Screw Technique
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Cortical Screw Technique Cons Learning curve Difficult to redirect after initial trajectory Difficult to perform posterolateral grafting
Slide 46-

Interspinous Devices “Inter Spinous Fusion” Coflex-F Minuteman Minimally invasive Require preservation of spinous processes Data limited to small case series
Slide 47-

Conclusions Open decompression and fusion remains gold standard Role of newer techniques continues to evolve Key points Thorough decompression Meticulous graft bed preparation Choose best fixation technique in your hands
Slide 48-

Thank you!