ILIF Interlaminar Lumbar Instrumented Fusion

ILIF Interlaminar LumbarInstrumented FusionAnton Thompkins, M.D.

Anton Thompkins, M.D.EDUCATION:BS, Biology, DePauw University, Greencastle, INMD, University of Cincinnati College ofMedicineRESIDENCY: Orthopedic Surgery, IndianaUniversity Medical Center, Indianapolis, INFELLOWSHIP: Spine, Panorama Orthopedics,Denver, COBOARD CERTIFICATION: American Board ofOrthopedic SurgeryMEMBERSHIPS: American Academy of OrthopedicSurgeons, J. Robert Gladden, Orthopedic Society,Indiana State Medical Association, Indiana OrthopedicSociety, Porter County Medical Society, SOLAS member,NASS member

Will ILIF Replace Pedicle ScrewInstrumentation/Procedures?

WHY REPLACE TRADITIONAL PROCEDURESWITH MAXIMUM ACCESS SURGERY?

Traditional Posterior Instrumented FusionBilateral pedicle screwsWide dissection totransverse processesSignificant bone removalPotential for increasedcomplicationsOften paired withinterbody implantsPedicle Screws

Potential Instrumented FusionComplicationsPotential destabilizationWide exposure may cause severeatrophy of paraspinal musclesIncreased OR time, blood loss, infections,dural tear, malpositioned implants,pseudarthrosis, reoperationAdjacent segment degenerationOlder patient population with likelycomorbiditiesCardiovascular diseaseLow respiratory reserveExercise intoleranceDiabetesOsteoporosis, etc.Pedicle Screws

Potential Improvements forInstrumented FusionsSurgeons determined to:Reduce patient morbidityMinimize dissection and boney removalMinimize operative timeReduce complications with geriatric or comorbid patientsLimit surgery to midline if possible

Historical PerspectiveThe PastThe PresentThe FutureDr. Hibbs first spinalfusion in 1912; corticaltibial wedge betweenthe spinous processesCervical Gallie fusion withsublaminar wiring

ILIF ConstructILIF (Interlaminar Lumbar Instrumented Fusion)1. Improved DirectDecompression2. Posterior Fusion3. Posterior Fixation4. Biologics

WHO: IDEAL ILIF PATIENTIdeal ILIF Patient: Older Patient Suffering from LumbarSpinal Stenosis with Mild to Moderate InstabilityThe total population over 60years-old worldwide will rise from605M in 2000 to 1.2B in 2025.Lumbar spinal stenosis (LSS) is themost common reason for backsurgery in patients over 50.“Spinal stenosis is the most common surgical indication for the geriatric patient.”SOURCE: Katz JN : Lumbar spinal fusion. Surgical rates, costs, and complications. Spine: 20; 78S-83S, 1995

WHERE TO USE ILIF ?• Elderly, low demand patient• Central, lateral recess, andforaminal stenosis• Instability is present, buttrying to avoid pedicle screws• Co-morbidities are presentILIF Midline IncisionTraditional Approach

WHEN NOT TO USE ILIF“If you’re a hammer, not every indication is a nail.”Severe osteoporosisIsthmic spondylolisthesis (pars defect)Spondylolisthesis with gross instability (>Grade 1)Previous laminectomy at operative level

WHY THE ILIF PROCEDUREAllow safe access to neural elements fordecompressionMinimal disruption to the soft tissueMaintain sagittal balanceFusion surface equal or better than currentstandardRobust fixation without burning any bridgesTime saving

ILIF/Affix in the Continuum of CareAffix® as an adjunct to interbody fusion: XLIF, TLIF, ALIFXLIF® + XLP® + AFFIX IIXLIF + ILIFCortical Screws + ILIFTLIF + UNILATERAL DBR® II+ AFFIX IIALIF + Halo® Plate+ AFFIX IIILIF at L5-S1

Case StudiesPedicle Screw Replacement

Case Presentation # 1The 90% Patient Profile•Sex: Female•Age: 89 YO•Physical Complaints: Back and Leg Pain•Diagnosis: Stenosis - central, lateral recess, foraminal• Surgical Plan: ILIF L4-5 with decompression

Case Presentation # 1• Fixation: 35mm Affix® II• Spacer: 12mm Magnitude• EBL: 125cc

Case Presentation # 2The 5-10% Patient Profile• 58 y/o male• 2-year history of LBP• Bilateral anterior thigh pain andintermittent inguinal discomfort;LBP becoming more disabling• L2-3 spondylolisthesis withstenosis• Central, lateral recess• Comorbidities: exam non-focal• TREATMENT: L2-3 XLIF® withILIF

The L5-S1 Patient Profile• Patient: 53 y/o male withan acute onset of left legand severe LBP. Pt s/pmicro 3 years prior• PE: Weakness with PF4/5, Achilles Reflex absentand 10/10 painCase Presentation # 3

Case Presentation # 3• Patient underwent an L5/S1 ILIF with the bladed plate• Leg pain had immediate resolution• Incision equal or smaller than previous microdiscectomy

Dr. Thompkins ILIF + TLIF Technique250+ cases with ILIF/TLIF approachAverage blood loss: 120ccAverage length of surgery: 1:25Average length of stay: 2.5 daysPreliminary VASRadicular – 75% reductionLBP – 60% reduction

Dr. Thompkins TLIF + ILIF TechniqueAdvantages-Increased fusion surface-Anterior columnsupport- Possible increasedfusion rates andconstruct rigidity-Possible decreasediscogenic back painDisadvantages-Increased operativetime-Increased cost-Minor increase bloodloss

Will/Should ILIF ReplacePedicle ScrewInstrumentation/Procedures?Yes- Augmentation foranterior support- Pt with significantcomorbitiesNO- Deformity case- Isthmic spondylolisthesis- Gross instability- Stenosis with mild tomoderate instability

In Summary . . . MINIMALLY INVASIVE IS : Less operative time Less blood loss Less postoperative pain Less post op medications Less hospital stay Rapid return to normalactivity Improved Quality of Life

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