New developments in Spine Surgery for Low Back Pain

1. Military Hospital Queen Astrid Brussels
Belgian Back Society
10-11 december 2010
Surgical Treatment
of Low Back Pain &
Sciatics
LEFLOT Jean-Louis
Lieutenant Colonel
Orthopaedic Surgeon
Jean-Louis.Leflot@mil.be

2. Disc Herniation

3. Disc Herniation

4. Disc Herniation

5. Facet joints « Overloading »

6. Failure of the conservative treatment
• Medical treatment
• Physiotherapy
• Infiltration « Pain Clinic »

7. DISCECTOMY

8. DISCECTOMY
Fibrosis

9. DISCECTOMY
Thinning of the disc
• Recurrence of disc herniation
• Foramenal stenosis
• Facet joints « overloading »

10. DIAM

11. DIAM
Man 42Y
Chronic Low Back Pain and Irritation L4 Left
Intra- and Extraforamenal Disc Herniation

12. Device Intervertebral for Assisted Motion
6 months after discectomy and DIAM L4L5
No more leg pain and good relief of the lumbagos
Normal height of the intervertebral disc

13. DIAM ou INTRASPINE
INDICATIONS
DISCECTOMY HYPERLORDOSIS
- Massive herniated disc leading - Facet joints overloading
to substantial loss of disc material
- Recurrence of herniated disc
- Herniation of a transitional disc with
sacralization of L5
DEGENERATIVE DISC DISEASE
- Topping off above or below the fused
segment, to support newly created loads.
- Isolated Modic I lesion leading to chronic
low-back pain.

14. Disc Arthroplasty
Man 39Y (Infantery)‫‏‬
Chronic Low Back Pain and Sciatic L5 right
Disc Hernia L4L5 right
Discopathy from levels L3L4, L4L5, L5S1
Severe L4L5 and L5S1

15. Disc Arthroplasty
ALIF L5S1 + TDA L4L5
Only 1 approach (RetroPeritoneal) !
Control after 6 months
No more lumbago & sciatic

16. Disc Arthroplasty
Goals of Lumbar TDA ?
• Pain relief
• Improved function
• Restoration of the sagittal balance
• Increased foramenal height
• Avoidance of adjacent level breakdown
• Longevity

17. Disc Arthroplasty
The retroperitoneal
approach is very
little dilapidating
•It preserves the lumbar muscles
•It avoids the intraspinal fibrosis

18. Disc Arthroplasty
Retroperitoneal Approach

19. Disc Arthroplasty
« Minimal invasive surgery »
A very good view of the intervertebral space is
possible with a mini-access (5 cm)‫‏‬

20. Disc Arthroplasty

22. Accelerated degeneration
of the adjacent segments
NO …
Disorder of the
sagittal balance ?
BUT …

23. Dynamic Instability
Disc degeneration L4L5 (L3L4)‫‏‬
Facet osteoarthritis
Disc protrusion
Spinal and foramenal stenosis
Dynamic
Instability

24. Hypermobility above fusion !
HIGH RISK after PLIF !

25. ALIF is beter than PLIF
Man 32 Y
(Infantery)

26. ALIF is beter than PLIF
ALIF
restore :
• Disc Space & Lumbar Lordosis
• Foramenal Height
• Facet Decompression
Combined Anterior & Posterior Fusion
permits :
• Circonferential Fusion
• No intra-canalaire intrusion
• No risk of peri-neural fibrosis
N.B. We can perform a DIAM stabilization above the
fusion to avoid the hypermobility

27. ALIF

28. AXIALIF

29. AXIALIF

30. AXIALIF
Indications
- Discopathy L5S1
without hernia
- Spondylolisthesis L5S1
grade 1
+ Posterior fixation

31. Conclusion
• Disc Hernia
• Disc Height
• Foramenal Height
• Fibrosis
• Sagitall Balance
Jean-Louis.Leflot@mil.be