Vol.6 成人脊柱変形における M ISt手技の応用 脊椎側方アプローチを用いた成人脊柱変形手術の低侵襲化 Reconstruction with spinal lateral approach for adult deformity 金村 徳相 先生 愛知県厚生連江南厚生病院 脊椎脊髄センター 整形外科 成人脊柱変形におけるMISt手技の応用 荒瀧 慎也 先生 香川労災病院 整形外科 田中 雅人 先生 岡山大学病院 整形外科
MISt MISt MIStLIF MISt MIStMISS-VOICE MISt MISt http://s-mist.org MISS Voice 2 MISS VOICE vol. 6
Theme #.1 Reconstruction with spinal lateral approach for adult deformity Lateral lumbar interbody fusionlif Lateral access surgery Adult spinal deformity LIF LIF 1,2) LIFMIStLIF ligamentotaxis 3-6) 7-9) Cobb30 113LIF PS PSPPS Cobb30Cobb20 2010 LIF2L5/S3 5LIF47 L5/SPLIFTLIFLIF 1PontePLIFTLIF LIF 1/3 10-13) vol. 6 MISS VOICE 3
Tip #.1 1 78 1 XCobb28 LL28PI-LL-24 SVA 5.3 cmpt 22TPA 22 LIFPPSViper DePuy Synthes L2/3L3/4L4/52 LL49PI-LL -3 SVA4.8cmPT 12TPA 12 1MRI2 3 1 LIF + PPS 3 () X 1X 2MISt LIF PPS 3 L2/3 L3/4 MRI T2 1MRI T2 MRI T2 1MRI T2 4 MISS VOICE vol. 6
2 67 4 1 JOA15GERDLIF2 XTh12L4Cobb55LL 24 Th10-L258 6.9 cm4lifl1/2l4/5 30LL 62Th10-L228 1Th10 Expedium DePuy Synthes S2AISS1 PS Th1012L5/SPLIF 5113LL 77 Th10-L24PT -2TPA5 4LIF2 X XLIFX 1X 5 100 S2AISS1 PS vol. 6 MISS VOICE 5
LIF PSOVCR Ponte PLIFTLIF LIF LIF LIF LIFPSO VCRPonte LIF LIF 3 80 6 T-score 2.8 SD X 18 SVA 17.7 cmtpa 67XLIF4 L1/2 L4/52 Th10 L5/S PLIF LL 53 SVA 2.3 cmtpa 18 LIF115 LIF7 6LIF2 7CTLIFL1 L4 X LIFX X CT CT 6 MISS VOICE vol. 6
LIF LIF P S O posterior VCR 2015 LIF LIF 4 70 8-11 T-score 2.9 SDTh1112 Th11Th12 Th10-L2 82 PT 30 SVA 2.2cmTPA 24 2 Th4-L12 PT 21SVA 0.5cmTPA 15 L2/3L3/4 LIF 8 2 92 X MRI T2 CT X X CT vol. 6 MISS VOICE 7
10 h11-129 L2/3L3/4 LIF 2 Th11-12 2 112 X LIFX X LIF LIF33% LIF 170197% LIF10% 20 14-15) 8 MISS VOICE vol. 6
16) 1 LIF CTLIF 12 12CT CTLIF MISt 13LIFPPS MISt LIF 90 PPS 3 L5/SPLIFTLIF LIF PPS 17) 1) Ozgur, B.M., et al.: Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 6 (4): 435-43, 2006. 2) Fujibayashi S, Hynes RA, Otsuki B, et al.: Effect of Indirect Neural Decompression Through Oblique Lateral Interbody Fusion (OLIF) for Degenerative Lumbar Disease. Spine (Phila Pa 1976). 2014 Nov 11. [Epub ahead of print] 3) Oliveira, L. et al. A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine. 35(26 Suppl), 2010, S331-7. 4) Elowitz, EH. et al. Evaluation of indirect decompression of the lumbar spinal canal following minimally invasive lateral transpsoas interbody fusion: radiographic and outcome analysis. Minim Invasive Neurosurg. 54(5-6), 201-6, 2011. 5) Castellvi, AE. Indirect decompression of lumbar stenosis with transpsoas interbody cages and percutaneous posterior instrumentation. Clin Orthop Relat Res. 472(6), 1784-91. 2014. 6) (XLIF/OLIF)Surgical Technique45570-5812014. 7) Berjano, P., et al.: Far lateral approaches (XLIF) in adult scoliosis. Eur Spine J. 22 Suppl 2: S242-53, 2013. 8) Phillips, F.M., et al.: Adult degenerative scoliosis treated with XLIF: clinical and radiographical results of a prospective multicenter study with 24-month follow-up. Spine. 38: 1853-61, 2013. 9) Baghdadi, Y.M., et al.: Sagittal balance and spinopelvic parameters after lateral lumbar interbody fusion for degenerative scoliosis: a case-control study. Spine (Phila Pa 1976). 39(3): E166-73, 2014. 10),, XLIF57: 1547-1555, 2014 11) XLIFOLIFMB Orthopaedics 28(2): 76-86 2015. 12) Robert K. EastlackXLIF Bone Joint Nerve5355-3652015 13),,, extreme lateral interbody fusion(xlif)285 485-4942015 14) Rodgers WB, Gerber EJ, Patterson J : Intraoperative and early postoperative complications in extreme lateral interbody fusion. An analysis of 600 cases. Spine (Phila Pa 1976) 36 : 26 32, 2011. 15) Uribe JS et al : Visceral, vascular, and wound complications following over 13,000 lateral interbody fusions: a survey study and literature review. Eur Spine J. 24 (Suppl 3): 386-96, 2015. 16) Regev GJ, al : Morphometric analysis of the ventral nerve roots and retroperitoneal vessels with respect to the minimally invasive lateral approach in normal and deformed spines. Spine (Phila Pa 1976). 34(12): 1330-5, 2009. 17),,,, MIS-long fusion 285455-4662015. vol. 6 MISS VOICE 9
Theme #.2 MISt (Minimally Invasive spine Stabilization : MISt) (adult spinal deformity : ASD)MISt MISt ASD MISt ASDMISt ASD Glassman QOL Lafege QOL ASD Schwab500 Xparameter PI-LL<11SVA<47mmPT<22 pelvic incidence(pi) PImatch (lumbar lordosis : LL) PLIF/ TLIFpontecantilever techniquerod rotation techniquecompression and distractiontranslation YadlaASD 41.2% International Spine Study Group963review major complication7.6%4 5 ASD MISt 10 MISS VOICE vol. 6
LIF LIF LIF PSOposterior VCR 2015 LIF LIF <LIF> PLIF/TLIF L5/STLIF/ PLIF PPS PPS LIF PI-LLmismatch25 PPS flexible PPS L5/STLIF/PLIFsemi-open PPScanti-lever technique semi-open SAI screw <PPS> SAIcantilever technique sublaminar wiring ASDMISt LLIF PPS OLIF XLIF OLIFO arm Navigation C arm free vol. 6 MISS VOICE 11
C-arm free OLIF Navigation OarmCT Navigation ASDL1/2L4/54L1/2L2/3 L3/4L4/5 NavigationL3/4 Navigation NavigationX NavigationL3/4OLIFL4/5OLIF L1/2L2/3 12 MISS VOICE vol. 6
PPS + cantilever technique O armctnavigation (Th10Th12)cantilever techniquesemi-opennavigation3pps L1L4PPSL5S2L5/S TLIFSAI screwsemi-openscrewnavigation semi-open SAI screws1screwset screw cantileverscrewrodsai screw cantilever technique screwl1/2l4/5l5/s TLIFsemi-open Navigation vol. 6 MISS VOICE 13
64 64 PT 35PI 55 LL 1 PI-LL=54SVA 139mm LIFL1/2-L4/5LL 33 PI-LL=21PPS LL 57PT3512SVA139mm27mm LIFPPSPI-LL mismatch542 14 MISS VOICE vol. 6
ASD MISt LIF PI-LL mismatch25pps MISt 6 1/2 L4/5LIFL5/S TLIF proximal junctional kyphosis (PJK) MISLATASDalgorithm 7) MISt MISt MISt Glassman SD, et al : The impact of positive sagittal balance in adult spinal deformity. Spine, 30:2024-2029, 2005 Lafage V, et al : Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine, 34:E599-E606, 2009 Schwab FJ, et al: Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity : a prospective multicenter analysis. Spine, 38:E803-E812, 2013 Yadla S, et al: Adult scoliosis surgery outcomes: a systematic review. Neurosurg Focus, 28(3): E3, 2010 Mummaneni P, et al, 2011 AANS annual meeting Anand N, et al: Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis. Neurosurg forcus, 28(3):E6, 2010 Praveen V, et al: The minimally invasive spinal deformity surgery algorithm: a reproducible rational framework for decision making in minimally invasive spinal deformity surgery. Neurosurg Focus, 36(5): E6, 2014 vol. 6 MISS VOICE 15
製造販売元ジョンソン エンド ジョンソン株式会社デピューシンセス ジャパンスパイン事業部 101-0065 東京都千代田区西神田 3 丁目 5 番 2 号 T. 03 4411 6125 depuysynthes.jp 販売 : VIPER2スパインシス 番号 : 22400BZX00042000 販売 : VIPER2セ 番号 : 13B1X00204DS0052 販売 : Viper イド イ ー 番号 : 223ADBZX00029000 販売 : VIPER3Dセ 番号 : 13B1X00204DS0058 販売 : T-PALシス 番号 : 22500BZX00023000 販売 : T-PALセ 番号 : 13B1X00204SS0028 販売 : Expedium Plus スパインシス 番号 : 22500BZX00156000 販売 : Expediumセ 番号 : 13B1X00204DS0026 販売 : CoRoent XL PEEK ージシス 番号 : 22500BZX00197000 製造販売元 : ュー イシ ジャパン株式会社販売 : ススス ーション ーションシス 番号 : 22600BZX00110000 製造販売元 : ド 株式会社 J&J K.K. 2016 DSSJ306M-02-201610-NK