EuroSpine 2021 Vienna The Cadiss a new aid for spinal revision surgery with more selective dissection of the epidural fibrosis

1. Cadiss®, a new aid for revision spine surgery
with more selective dissection
M. Triffaux
Neurosurgery, Spine Unit
CHwapi B 7500 Tournai
07 october 2021

2. Cadiss®: what is that ?
Epidural Fibrosis: the nightmare for the surgeon
Revision Spine Surgery: a real challenge
My Cadiss® experience: more than 10 uses
The Cadiss® what can and cannot do

3. Cadiss®, what is that ?

4. Cadiss®, what is that ?

5. Cadiss®, what is that ?
Thank you very muh, Valerie
Now the Caddiss has no secrets for anyone

6. Cadiss®, what is that ?

7. Cadiss®, what is that ?

8. Cadiss®, what is that ?

9. Cadiss®, what is that ?
Is it too good to be true ?
No limitations in this study ?
?

10. Cadiss®, what is that ?
Is it too good to be true ?
No limitations in this study ?
?
?

11. Cadiss®, what is that ?
Is it too good to be true ?
No limitations in this study ?
No choice: I had to test it by myself …
10 cases / 6 months / 2 surgeons
It’s my opinion after 10 uses that I will
communicate to you

12. Cadiss®, what is that ?
Our limited experience after 10 cases
Study design
Dispositif CADDIS Auxin
Etude prospective 04.21
CAS __ __ AB SL MT
date op. : __ / __ / 2021
1. compléter Spine Tango dans HD4PD
2. Dans §4 Chirurgie technique item autre: CADDIS
3. ATCD infiltratif O non O inconnu O oui __ __ __ __ __ __ __ __ __
4. ATCD opératoire O non
O oui O même niveau O prévention par oxyplex, __ __ __ __ __ __ __
O type intervention précédante: O HDL O CLE O Fusion
O alt: __ __ __ __ __ __ __ __ __ __ __ __ __ __
délai entre les deux interventions __ __ mois __ __ années O non connu
5. Type d’intervention O HDL O CLE O FUSION 180° O à 360° O trauma
6. Modalités opératoires O open O MIS O NNV O arm
O autre: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
8. Fibrose canalaire O IRM O Ctscan O non évaluable
1./2
A B C D Total
___ /16 ___ /16 ___/16 ___/16 ___/16 _____ %
/16 % /16 %
2 13 10 63
4 25 12 75
6 38 14 88
8 50 16 100
A: 100 %. B: 75% C: 50% D: 25%
4 / 16 3 / 16 2 / 16 1/ 16
Niveau: L2 L3 L4 L5 S1

13. Epidural Fibrosis a nightmare ?
• Pathologic epidural fibrosis is a fibroblastic scare
• Hematoma of operative field is invaded by fibroblastes
and becomes granulation tissue

14. Epidural Fibrosis a nightmare ?
https://doi.org/10.1016/j.jot.2018.02.001

15. Epidural Fibrosis a nightmare ?
• It

16. Epidural Fibrosis a nightmare ?
• How to prevent the fibrosis ?
https://doi.org/10.1016/j.jot.2018.02.001

17. Epidural Fibrosis a nightmare ?
• How to prevent the fibrosis ?
• Good hemostasis ? Less bipolar use ?

18. Epidural Fibrosis a nightmare ?
• How to prevent the fibrosis ?
• Good hemostasis
• Suction drain
• MIS : smaller incision & less muscle trauma
• Preservation of epidural fat
• Preservation of ligamentum flavum
• Topic corticosteroid

19. Epidural Fibrosis a nightmare ?
• How to prevent the fibrosis ?
• Free fat grafting
• Barrier GEL

20. Epidural Fibrosis a nightmare ?
• How to prevent the fibrosis ?
• Free fat grafting
• Barrier GEL
• Barrier menbrane

21. Epidural Fibrosis a nightmare ?
• How to prevent the fibrosis ?
• Free fat grafting
• Barrier GEL
• Barrier menbrane
• Immunosuppressor Mitomycine C MMC
• Application of stem cells
• low dose radiotherapy

22. Epidural Fibrosis a nightmare ?
• Why that is a problem ?
• FBSS
• Revision surgery
• Accidental Dural Tears X3 > 16% ( // age, lumbar stenosis)
• Operative time > 6 h
• Lenght of hospital stay

23. Epidural Fibrosis a nightmare ?
• Why that is a problem ?
• more and more revision 5-18%
• an increasingly older population
• Belgian situation arond 2010

24. Epidural Fibrosis a nightmare ?
• Why that is a problem ?
https://asma.social/assets/209

25. Epidural Fibrosis a nightmare ?
• Why that is a problem ? % of revesion

26. Epidural Fibrosis a nightmare ?
• Why that is a problem ?

27. Epidural Fibrosis a nightmare ?
• The ADTs
• Incidence X3 for revision surgery -> 16%
• 10 steps algorithm for treatment
• Additional cost > 1.000 € ? / ADTs cf our cost study

28. Epidural Fibrosis a nightmare ?
• The additional cost of the ADTs
Study on the hospital bill of 10 consecutive ADTs cases
3 month period : 10 ADTs/ 167 = 6%

29. Epidural Fibrosis a nightmare ?
• The additional cost of the ADTs
Study on the hospital bill of 10 consecutive ADTs cases
Population: Revision 3 t, trauma 1 : B2 Th L

30. Epidural Fibrosis a nightmare ?
• The additional cost of the ADTs
Study on the hospital bill of 10 consecutive IDTs cases
Treatment of ADTs, 1 unresolved (trauma)

31. Epidural Fibrosis a nightmare ?
• The additional cost of the ADTs
Study on the hospital bill of 10 consecutive IDTs cases
Additional direct cost / ADTS: 1.140 €

32. Spinal revision a real challenge
• Spinal revision surgery is complexe and ungrateful
• It’s a succesion of small details
• Good results are not always there

33. Spinal revision a real challenge
• Pre op evaluation
• Change the approach ?
• Keep the bone contact
• Do not tear off
• Dissolve fibrosis ?

34. Our experience more than 10 cases
• Prepare the cartridge and the cannulated dissector

35. • Prepare the cartridge and the cannulated dissector
Our experience more than 10 cases

36. Our experience more than 10 cases
• Ideal case to start:
Posterior Interbody Fusion for late reccurent disc hernia

37. Our experience more than 10 cases
• Ideal case to start:
Posterior Interbody Fusion for late reccurent disc hernia

38. Our experience more than 10 cases
• Another case if you are not convinced: try on implants
It’s even easier to see the work of the Cadiss®

39. Our experience more than 10 cases
• A bad case :
67 ans y.o. man with comorbidity ++
1992 First arthrodesis L4L5
2008 AMOS Laminectomy L2L3L4 // DH L2L3
2019 Laminectomy Th12 L1 re L1L2L3L4: ADT
2021 Neurogene claudication

40. Our experience more than 10 cases
• A bad case :

41. Our experience more than 10 cases
• A bad case :

42. Our experience more than 10 cases
• A bad case :

43. Our experience more than 10 cases
• A bad case :
X
X
X
X

44. Our experience more than 10 cases
• Our 10 consecutive cases with Cadiss®
6 month period, 10 / 291 = 3,5 % , ADTs 1 with BS

45. The Cadiss® wath can and cannot do
This can facilitate dissection in epidural fibrosis
BUT 1. minimize the thicknes of epidural fibrosis
2. take the time for the product to work
3. wash the operative area with PL
AND 1. reduce the operating time
2. reduce the IDTs, reduce bleeding
3. reduce the lenght of hospital stay
It is same as hemostatic products, you always need to do a
good hemostasis: a careful dissection always be done

46. The Cadiss® wath can and cannot do
Other indications ?
epidural chimical adhesiolysis ?

47. Thank you