WHAT IS A FUSION OF THE LUMBAR SPINE

WHAT IS A FUSION OF THE LUMBAR SPINE? -OPEN-MINIMALLY INVASIVE-ANTERIOR APPROACH-POSTERIOR APPROACH-

“OPEN” APPROACH POSTERIOR ACCESS INITIAL EXPOSURE Midline incision through the skin down to then through the muscle to the bone of the spine

OPEN SURGICAL EXPOSURE SHOWS VISUAL STRIPPING AWAY MUSCLE AT ITS ATTACHEMENT TO THE UNDERLYING BONE, BLEEDING IS OFTEN EXTENSIVE, MUSCLE IS PERMANENTLY DAMAGED

OPEN SPINAL BONEY EXPOSURE EXPOSED BONE……MUSCLE LAYER IS HELD TO THE SIDE BY RETRACTORS THAT COMPRESSES ALREADY COMPROMISED TISSUES

OPEN POSTERIOR LATERAL FUSION EXPOSED BONE HAS BEEN FURTHER STRIPPED OF ITS OUTER SURFACE (DECORTICATION) THEN PEDICLE SCREWS ARE INSERTED, BONE IS OOZING BLOOD CONTINOUSLY

POSTERIOR LATERAL FUSION BONE IS CRUSHED INTO A BLOODY THICKENED SLURRY AND APPLIED TO THE BONE SURFACES WHERE STRIPPED, WOUND IS CLOSED

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 RATHER THAN THE BACK PART OF THE SPINE AS PREVIOUSLY SHOWN

-MINIMALLY INVASIVEPOSTERIOR FUSION TECHNIQUE “MAST TLIF” ONLY SKIN AND FAT LAYERS CUT. TUBES ARE INSERTED BETWEEN THE MUSCLE FIBERS. MUSCLES ARE NOT CUT OR STRIPPED.

-MINIMALLY INVASIVEPOSTERIOR FUSION TECHNIQUE “MAST TLIF” -DISC IMPLANTS ARE INSERTED THROUGH A TUBE-SCREWS & RODS INSERTED VIA A PUNCTURE THROUGH THE SKIN-

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

“TWO-IN-ONE” ALIF ANTERIOR CAGE/PLATE + POSTERIOR PEDICLE SCREWS NEEDS EXPOSURE SURGEON + FUSION SPINE SURGEON LONGER HOSPITIZATION + MORE SERVICES UTILIZIED FRONT AND BACK EXPOSURES

“MINIMAL ACCESS” DIRECT LATERAL-DLIF ANTERIOR INTERBODY FUSION ONE SURGEON MINIMAL BLOOD LOSS & MINIMAL MUSCLE DAMAGE HOME WITHIN 23 -48 HOURS.

LUMBAR FUSION DATA Minimally Invasive Lumbar Fusion Traditional Open Muscle Splitting Lumbar Fusion Difference Patient Time in Hospital 23 hrs 4. 5 days 88% Estimated Blood Loss 143 cc 439 cc 33% 89% 50% 39% Return to Work Rate

LUMBAR FUSION DATA(2010) 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 36% 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 78% $0 $3, 527 100% Physical Therapy Cost $487 $1, 415 $928 66% OR radiology costs $960 $1, 628 $668 41% $32, 281 $56, 383 $24, 102 43% Blood Transfusion Cost Total Cost