Suffering from Back or Leg Pain?

Minimally Invasive

Treatment Options for Degenerative Spine Conditions

El Paso Spine CenterDean E. Smith MD

Foundation Hospital

Dean E. Smith MDSpine Center

• Board Certified

• Fellowship Trained

• Spine Surgeon

• Practicing in El Paso Texas Since 1992

• Minimally Invasive Spinal Surgeries

• Major reconstructive Spinal Surgeries

• Cervical Spine

• Thoracic Spine

• Lumbar Spine

About Back and Leg Pain

• An estimated 10 million adults suffer from chronic back pain annually.

• Back pain is the #1 cause of healthcare expenditures in the U.S.

– Direct cost of over $50 billion for diagnosis, treatment, and rehabilitation

Back Pain Symptoms

• Acute pain

• Chronic pain

• Back pain can be felt constantly or intermittently and may be a dull ache or a sharp, piercing, or burning sensation.

• The pain can stay in one place or refer or radiate to other areas, such as the front, side, back, legs, and neck.

Back Pain Causes

• Muscles– Sudden, awkward movement, strained back muscles and ligaments, lifting heavy

objects, or using improper form when lifting objects

• Nerves– Pressure or impingement of

nerve roots in the spinal canal can be caused by: • Herniated discs• Collapsed disc spaces• Arthritic conditions• Bone spurs• Displacement of vertebrae

Back Pain Prevention

• Body Position– Lifting– Sitting– Sleeping– Standing

• Exercise– Aerobics– Stretching

• Other Considerations– Smoking– Weight

Non-Surgical Treatment Options

• Heat

• Medications

• Exercise

• Acupuncture

Surgical Treatment Options

• Once all non-surgical treatments have been exhausted, surgery may be the next step.

• “Symptoms and indications for back pain have not changed, but surgical treatment options have.”

• Spinal surgery treatment options are defined by the “approach,” or the way in which the surgeon accesses the spine.

• Each option has its own set of risks and benefits.

Traditional Surgical Approaches

BackFront Back

Surgical Approach XLif TLif ALif PLif

• eXtreme Lateral Interbody Fusion (XLIF)

• Advantages:– Does not require entry through sensitive

back muscles, bones, or ligaments or the retraction of major blood vessels anteriorly

– Made safe with the use of nerve monitoring technology

Side

Minimally Invasive Lumbar

Surgical Approaches

NeuroVision® JJB

• Advanced technology that provides intraoperative information about nerve safety

• Used successfully in over 100,000 spinal surgeries

A Minimally Disruptive Surgical Approach

Minimally Invasive Robot Lumbar

Laser Spinal Surgery

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• Only FDA-approved mechanical guidance system for spinal surgery

• Over over 5,000 procedures performed

• Available in only 63 sites worldwide

• Reduce fluoroscopy/risk• High confidence and Safety in

difficult surgeries

Mazor Robotics Renaissance™

Patient BenefitsMinimally Invasive Surgery

Source:

*Wright N, XLIF – the United States experience 2003-4, International Meeting on Advanced Spine Techniques, 2005, Banff, Canada.

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Benefits

• Reduced post-op pain

• Shorter hospital stays

• Faster recovery

Rapid return to normal activity

Minimally Invasive

Procedure

• Less tissue disruption

• Minimal blood loss

• Nerve safety (NeuroVision®)

Lumbar Anatomy

Indication Degenerative Disc Disease (DDD)

Indication Degenerative Disc Disease (DDD)

• Symptoms– Pain in the back, buttocks,

or leg

• XLIF Correction– Reduces motion between

the vertebrae– Corrects alignment– Restores proper disc height– Alleviates pain

Disc Degenerationbefore XLIF

Restoration of Heightafter XLIF

Indication Degenerative Disc Disease (DDD)

• Symptoms– Pain in the back, buttocks,

or leg

• XLIF Correction– Reduces motion between

the vertebrae– Corrects alignment– Restores proper disc height– Alleviates pain

Disc Degenerationbefore XLIF

Restoration of Heightafter XLIF

Degenerative Disc DiseaseCase Study

- x-rays (AP and lateral)

- MRI if relevant

Surgical Incision

IndicationSpondylolisthesis

Indication Spondylolisthesis

• Symptoms– Impingement of nerves and

fatigue of back muscles

• XLIF Correction– Reduces motion between

vertebrae, corrects alignment, and restores disc height

Spondylolisthesis(Malalignment)

before XLIF

Restoration of Alignmentand Disc Height after XLIF

Open Spinal Surgery

Open Spinal Surgery

Spondylolisthesis Case Study

- Intra-op fluoro or photos, if available

- keep to a minimum, fitting on this one slide only

Indication Degenerative Scoliosis

• Symptoms– Back and/or leg pain due to muscle

fatigue and nerve impingement

• XLIF Correction– Restores proper alignment and

disc height

Degenerative Scoliosis before XLIF

Restoration of Alignmentafter XLIF

Degenerative Scoliosis Case Study

- x-rays (AP and lateral)

- MRI if relevant

Degenerative Scoliosis Case Study

Case Study

- Intra-op fluoro or photos, if available

- keep to a minimum, fitting on this one slide only

STEM CELLS

•Osteocel is an allograft cellular bone matrix retaining native mesenchymal stem cells (MSCs) and osteoprogenitor cells

•provides all 3 components for bone formation: 1. osteoconductivity: cancellous scaffold2. osteoinductivity: MSC growth factor3. osteogenicity: osteoprogenitor cells

Nate Quarry, Ultimate Fighter & XLIF® Surgical Patient, June 2006 – Returns to Octagon 15 Months After Surgery

Questions?

Thank You

Elpasospinecenter.com