percutaneous lumbar fusion

[ParaVert]

Anybody know much about this? I've been doing a little reading and it seems very straightforward. Drive a K-wire down each pedicle (just like a V-plasty), then thread the pedicle screws down each K-wire, then push this god-aweful linking spike to connect. Pretty cool.

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[Disciple]

One pain guy I know of is doing it.

Called it a T-Lift?


He was doing it with a neurosurgeon in the room, so I'm not sure yet if it's a good idea for pain docs to do it.

 

[Ligament]

Yes, you are likely talking about Bradley Goodman, a pain doc in Birmingham, Alabama. I observed him doing this procedure with his neurosurgery buddy.

One pain guy I know of is doing it.

Called it a T-Lift?


He was doing it with a neurosurgeon in the room, so I'm not sure yet if it's a good idea for pain docs to do it.

 

[ParaVert]

So what did you think of the procedure? Why was he with a NSGn? Were they doing evoked potential monitoring? Was there a significant dissection? What company makes the hardware? What was their indication for this procedure vs PLIF? Where can I get more information about it? I'm ready for my weekend cadaver course

Seriously, there needs to be a lot of these procedures done without complications that require urgent open intervention before a non-surgeon can justify performing these. Then again, the same has been said of every pain procedure more complicated than an ESI (eg: kyphoplasty, pump/stim implants, RF).

 

[lobelsteve]

This has disaster written all over it.

 

[Disciple]

Called it a T-Lift?

Sorry, TLIF.

I think he was doing it with a Neurosurgeon because of priviledges/credentialing issues, and of course, just in case for back-up.

Here's an article I found online:

http://www.medscape.com/viewarticle/536577

However, the technique in this article describes performing a facetectomy, discectomy and placing bone graft, and then lists complications such as dural tear, etc.

I don't know, pumps/stims are one thing, as not all surgeons want to be involved with that stuff. Performing fusions (even percutaneous), is getting into their bread and butter, which I'm sure most of them would be totally against.

 

[paindefender]

I have assisted in several of these procedures. Most common indication is a patient wiht spinal stenosis and spondylolisthesis. Results for this indication are excellent. Results for discogenic pain are just about like everything else that you do for discogenic pain. It requires a fair amount of dissection, you need to decompress (do a laminectomy) if you do it for spinal stenosis. Op time about 1 1/2 hour. Obviously not in the scope of any pain doctor. Equipment and training can be obtained from Medtronic.

 

[lobelsteve]

I have assisted in several of these procedures. Most common indication is a patient wiht spinal stenosis and spondylolisthesis. Results for this indication are excellent. Results for discogenic pain are just about like everything else that you do for discogenic pain. It requires a fair amount of dissection, you need to decompress (do a laminectomy) if you do it for spinal stenosis. Op time about 1 1/2 hour. Obviously not in the scope of any pain doctor. Equipment and training can be obtained from Medtronic.

Can you please explain a perc lami. Unless you are using some type of laser or pulverizer, I cannot see how you can cut off a lamina through a perc incision.

 

[paindefender]

We also do the lamis for paddle leads with this device

 

[Tenesma]

the "sextant" system from medtronic - brilliant idea but every spine surgeon i have spoken to has tried it and ended up ditching it... doesn't save them much time, and most people need a laminectomy anyway and the difference in outcome is not so big...

what i am more and more impressed with is the TFAS (total facet arthroplasty) basically an artificial facet joint - outcomes are the same, but at least the patients are out of bed doing things a few days after the procedure instead of what you see with most fusions...