1. WHAT is a FUSION of the LUMBAR SPINE?
-OPEN-
-MINIMALLY INVASIVE-
-ANTERIOR APPROACH-
-POSTERIOR APPROACH-

2. “Open” Approach Posterior Access Initial Exposure
INCISION THROUGH SKIN THEN FATTY LAYER THEN THROUGH MUSCLE TO THE BONE
Midline incision through the skin down to then through the muscle to the bone of the spine

3. Open Surgical Exposure
SHOWS VISUAL STRIPPING AWAY MUSCLE AT ITS ATTACHEMENT TO THE UNDERLYING BONE, BLEEDING IS OFTEN EXTENSIVE, MUSCLE IS PERMANENTLY DAMAGED-STILL CONSIDERED THE “STANDARD” BY SOME SPINAL SURGEONS!
SHOWS VISUAL STRIPPING AWAY MUSCLE AT ITS ATTACHEMENT TO THE UNDERLYING BONE, BLEEDING IS OFTEN EXTENSIVE, MUSCLE IS PERMANENTLY DAMAGED

4. Open Spinal Boney Exposure
EXPOSED BONE……MUSCLE LAYER IS HELD TO THE SIDE BY RETRACTORS THAT COMPRESSES ALREADY COMPROMISED MUSCLE AND FATTY LAYER TISSUES
EXPOSED BONE……MUSCLE LAYER IS HELD TO THE SIDE BY RETRACTORS THAT COMPRESSES ALREADY COMPROMISED TISSUES

5. Open Posterior Lateral Fusion
EXPOSED BONE HAS BEEN FURTHER STRIPPED OF ITS OUTER SURFACE (DECORTICATION) AND PEDICLE SCREWS ARE INSERTED, BONE IS OOZING BLOOD CONTINOUSLY
EXPOSED BONE HAS BEEN FURTHER STRIPPED OF ITS OUTER SURFACE (DECORTICATION) THEN PEDICLE SCREWS ARE INSERTED, BONE IS OOZING BLOOD CONTINOUSLY

6. Posterior Lateral Fusion
BONE IS CRUSHED INTO A BLOODY THICKENED SLURRY AND APPLIED TO THE BONE SURFACES WHERE STRIPPED, WOUND IS CLOSED
BONE IS CRUSHED INTO A BLOODY THICKENED SLURRY AND APPLIED TO THE BONE SURFACES WHERE STRIPPED, WOUND IS CLOSED

7. Open TLIF with Pedicle Screws and Interbody Cage
THIS “TLIF” OPEN TECHNIQUE STRIPS LESS MUSCLE, AND USES THE DISC SPACE AS THE AREA FOR THE FUSION TO OCCUR RATHER THAN THE BACK PART OF THE VERTEBRAE AS PREVIOUSLY SHOWN
THIS “TLIF” OPEN TECHNIQUE STRIPS LESS MUSCLE, AND USES THE DISC SPACE AS THE AREA FOR THE FUSION RATHER THAN THE BACK PART OF THE SPINE AS PREVIOUSLY SHOWN

8. -MINIMALLY INVASIVE- POSTERIOR FUSION TECHNIQUE “MAST TLIF”
ONLY SKIN AND FATTY SUB-SURFACE LAYERS CUT. TUBES ARE INSERTED BETWEENT HE MUSCLE FIBERS. MUSCLES ARE SEPERATED, NOT CUT OR STRIPPED. ALL OF THE NEURO/DISC/BONE/FUSION WORK IS PERFORMED THROUGH THE TUBES.
ONLY SKIN AND FAT LAYERS CUT. TUBES ARE INSERTED BETWEEN THE MUSCLE FIBERS. MUSCLES ARE NOT CUT OR STRIPPED.

9. -MINIMALLY INVASIVE- POSTERIOR FUSION TECHNIQUE “MAST TLIF”
IMPLANTS ARE INSERTED THROUGH A TUBE OR VIA A PUNCTURE PORTAL THROUGH THE SKIN AND THEN BETWEEN THE MUSCLE FIBERS
CIRCUMVENTS NEED FOR ANTERIOR EXPOSURES THROUGH THE ABDOMEN AT THE TWO LOWEST DISCS SEGMENTS
-DISC IMPLANTS ARE INSERTED THROUGH A TUBE-
-SCREWS & RODS INSERTED VIA A PUNCTURE THROUGH THE SKIN-

10. ANTERIOR INTERBODY FUSION “ALIF” EXPOSURE
INCISION THROUGH FRONT OF ABDOMEN INVOLVES CUTTING THROUGH BELLY MUSCLES AND AVOIDING DAMAGE TO INTESTINES, VESSELS, NERVES, AND BLADDER STRUCTURES
INCISION THROUGH FRONT OF BELLY
INVOLVES CUTTING THROUGH MUSCLES
AVOIDING DAMAGE TO INTESTINES, VESSELS,
NERVES, AND BLADDER STRUCTURES

11. “TWO-IN-ONE” ALIF Anterior Cage/Plate + Posterior Pedicle Screws
NEEDS EXPOSURE SURGEON + FUSION SPINE SURGEON. MULTIPLE SURGICAL PROCEDURES, LONGER HOSPITIZATION, MORE SERVICES UTILIZIED, FRONT AND BACK EXPOSURES
NEEDS EXPOSURE SURGEON + FUSION SPINE SURGEON
LONGER HOSPITIZATION + MORE SERVICES UTILIZIED
FRONT AND BACK EXPOSURES

12. “MINIMAL ACCESS” Direct Lateral-DLIF Anterior Interbody Fusion
DLIF! ONE SURGEON. MINIMAL BLOOD LOSS. MINIMAL MUSCLE DAMAGE. HOME WITHIN 23 HOURS. SAME GOALS ACHIEVED AS IN TRADITIONAL TWO-IN-ONE ALIF!
ONE SURGEON
MINIMAL BLOOD LOSS & MINIMAL MUSCLE DAMAGE
HOME WITHIN HOURS.

13. Lumbar Fusion Data Minimally Invasive Lumbar Fusion
Minimally Invasive Lumbar Fusion
Traditional Open Muscle Splitting Lumbar Fusion
Difference
Patient Time in Hospital
23hrs
4.5days
88%
Estimated Blood Loss
143cc
439cc
33%
Return to Work Rate
89%
50%
39%

14. Lumbar Fusion Data(2010) Minimally Invasive Lumbar Fusion
Minimally Invasive Lumbar Fusion
Traditional Open Muscle Splitting Lumbar Fusion
Total Diff
% Diff
OR Cost
$11,200
$17,500
$6,300
36%
Anesthesia Cost
$2,720
$4,250
$1,530
Implant Cost
$14,249
$14,738
$489 3%
Recovery Room Cost
$1,008
$1,512
$504
33%
Hospital Cost
$832
$8,100
$7,268
90%
Medication Cost
$561
$2,525
$1,964
78%
Labs
$264
$1,188
$924
Blood Transfusion Cost $0
$3,527
100%
Physical Therapy Cost
$487
$1,415
$928
66%
OR radiology costs
$960
$1,628
$668
41%
Total Cost
$32,281
$56,383
$24,102
43%