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Expanding PLIF Indications

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Expanding PLIF Indications. Expanding PLIF Indications. In ... F. 12/64 Neurology Opinion Jan 02. Bladder dysfunction, unable to weight bear on left leg ... – PowerPoint PPT presentation

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Title: Expanding PLIF Indications


1
Expanding PLIF Indications
2
Expanding PLIF Indications
  • In patients with Normal MRI, but a ve
    discogram
  • Severe Leg Pain DDD , without compression
  • Disc Prolapse
  • Degenerative Scoliosis

3
AA. M16. C/o LBP x 3 years.
  • Cannot go to school x 2 years
  • Seen Psychiatrist- all clear
  • Locally tender at L5/S1
  • Many courses of Physiotherapy.

?? cause
4
AA. M16. LBP x 3 years
  • Positive discography at L5/S1
  • Treatment Options
  • Do Nothing( easy - more physio)
  • Artificial Disc
  • ALIF
  • 360 fusion
  • PLIF

5
L5/S1 PLIF . Complete relief of LBP. Back at
school.
Thank you for giving me my son back
6
Theory
  • LBP occurs due to inflammation in the disc.
  • Degeneration on MRI not seen, especially in
    younger patients.

7
PC. F. 12/64 Nurse
C/o some LBP and severe Left Leg Pain since
March 2000. Off work 3 yrs. Illness
behaviour Sensation of numbness and coldness in
whole left leg Weakness and giving way of left
lower limb
8
PC. F. 12/64 Nurse
April 01- Left L4/5 nerve root block eased pain
x 4 days Oct 01 Intra-discal injection of
steroid and marcain L4/5. 70 back pain releif,
30 leg pain relief. Epidural- Feb 02- no relief.
9
PC. F. 12/64 Neurology Opinion Jan 02
  • Bladder dysfunction, unable to weight bear on
    left leg
  • Walks with 2 elbow crutches
  • SLR 20 on left
  • Global weakness left leg
  • Decreased sensation L2 downwards- peri-anal
    sensation normal. Impaired vibration on left.
  • Diagnosis Probably Functional

10
PC. F. 12/64 Nurse
March 2002 L4/5 PLIF LBP 90 better. Leg pain
Gone Returned to work No recurrence
11
Theory
  • Leg Pain is caused by non-compressive causes as
    well.
  • ? Cytokines leaking onto nerve
  • ? Irritation of the Sinuvertabral nerve

12
AB. M20. Lt Sciatica.
6 month history. On Morphine. Epidural worked for
24 hrs. ? Surgery. ? What sort.
13
AB. Lt TLIF. Single Midline Cage.
L5/S1 TLIF from Left side. Complete relief of
sciatic symptoms.
14
MC. F 12/50. Central Disc Prolapse L5/S1.
16/10/97
Central Disc prolapse
Oct 97, sudden severe LBP, dribbling urine and Rt
Leg Pain. Symptoms settled in one week, but then
recurred . Central disc prolapse L5/S1, causing
an irritable bladder and LBP. Sitting a problem.
15
Indications in Disc Prolapse
  • Long h/o LBP
  • Advanced degeneration in disc
  • Broad based postero-lateral disc protrusion
  • Central disc protrusion.

?? Which disc after discectomy alone, will go on
to fail in loading
16
Ronald Boagey. 14/6/40
  • LBP and Bilateral Leg Pain 8 years.
  • Stands stooped forwards and to the left.
  • Walks up his thighs
  • SLR50 degrees bilat
  • No neurodeficit.
  • Severely disabled
  • Epidural, Physio no good.
  • Claudication distance 50 yds.

17
L4/5
L5/S1
18
(No Transcript)
19
Blood loss 1800cc. Op time 6 hrs Hospital stay
5 days. L3-S1 PLIF.
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