NASS-ESMA

The Translation PlateA Novel Approach to the Treatment of Isthmic Spondylolisthesis andDegenerative Disc Disease : 

The Translation PlateA Novel Approach to the Treatment of Isthmic Spondylolisthesis andDegenerative Disc Disease Cliff Tribus MD

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Traditional Surgical Approaches Posterior fusion +/- decompression Same with TLIF/PLIF ASF/PSF

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Is Decompression Necessary? Many do “just because it’s there” Instrumentation will make up for the instability Carragee, E The addition of decomp. to fusion does not improve results in low grade spondy’s NASS award paper ‘97 Prospective, randomized Yes NO

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Enhanced By Anterior Distraction? After ASF of a planned ASF/PSF procedure, foraminal stenosis appears decreased

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Why Anterior Approach to Spondy? Save posterior exposure Reestablish anterior column Many surgeons now well versed and comfortable with anterior approaches Cage technology limitations are clarifying

Stand Alone ALIF for Spondylolisthesis is a Validated Approach : 

Stand Alone ALIF for Spondylolisthesis is a Validated Approach Aunoble, Stephane MD*; Hoste, David MD*; Donkersloot, Peter MD†; Liquois, Frederic MD‡; Basso, Yann*; Le Huec, Jean-Charles MD, PhD*Video-assisted ALIF With Cage and Anterior Plate Fixation for L5-S1 Spondylolisthesis Journal of Spinal Disorders and Techniques Volume 19(7), October 2006, pp 471-476. Pavlov PW, Spruit M, Havinga M, et al. Anterior lumbar interbody fusion with threaded fusion cages and autologous bone grafts. Eur Spine J. 2000;9:224–229. Carragee EJ, Swan JB, Malek F, Van Den Haak e, Alamin TF, Hurwitz E, Surgical Treatment for Unstable Low-Grade Isthmic Spondylolisthesis in Adults: A prospective Controlled Study of Posterior Instrumented Fusion compared with Combined Anterior-Posterior Fusion. NASS 2006. (Outstanding Paper Award)

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Features and Components of the T-Plate Face plate Interbody Arms – The interbody arms have grooves on the top and bottom. These grooves receive the interference screws and converts the smooth interbody arms to a threaded device Screws L-5 Bone x 2 Interference Screws x4 Locking Plate S-1 Screws x 2

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Features and Components of T-1 Locking Plate – The locking plate prevents back out of the 8 screws. L5 Bone Screw x 2 – The L-5 bone screws provide unicorticle purchase into the body of L5. Interference Screw x 4 – The interference screws are the final screws placed. They convert the interbody arms of the spondy plate to a threaded device, thus resisting the shear forces across the disc space. S1 screws – The S1 screws are meant to be placed with bicorticle purchase across the sacral ala lateral to the facet joint of L5-S1. The bicorticle purchase provides maximal resistance against the primary mode of failure…the shear forces of L5 sliding forward on S1.

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Features and Components of T-2 Interference Screw x 4 – The interference screws are the final screws placed. They convert the interbody arms of the spondy plate to a threaded device, thus resisting the shear forces across the disc space. L5 Bone Screw x 2 – The L-5 bone screws provide unicorticle purchase into the body of L5. Set Screws x 2 – The set screws secure the Spondy plate to the S-1 plate after the reduction instrument has reduced the spondylolisthesis. S1 screws – The S1 screws are meant to be placed with bicorticle purchase across the sacral ala lateral to the facet joint of L5-S1. The bicorticle purchase provides maximal resistance against the primary mode of failure…the shear forces of L5 sliding forward on S1. S-1 Plate – The S-1 plate is affixed to the sacral promontary after preparation with the mill guide and end cutting burr T-2 Spondy Plate Locking Plate – The locking plate prevents back out of the 8 screws.

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Plan incision inferior – Must be parallel to endplate of S-1 or below Retroperitoneal approach Mobilize and protect local vasculature Complete discectomy with resection of posterior osteophytes Placement of first interbody distractor Planning the Incision and the Anterior Approach

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The initial distraction is a critical step. If the spondylolisthesis reduces with the passive distraction, the surgeon may then proceed with placement of T-1 (The phase I Translation Plate) If the spondylolisthesis does not reduce with the passive distraction, the surgeon should proceed with placement of T-2 (The phase II Translation Plate) Surgical Technique

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Anatomic Reduction Persistent Spondylolisthesis T-1 T-2 Surgical Technique

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The T-1 Plate

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Preop Film showing Grade I Spondylolisthesis Distraction provides passive reduction of the Spondylolisthesis. The T-1 plate may be used.

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The T-1 Plate can then be placed, stabilizing the reduced spondylolisthesis The Bone screws and Interference screws are placed. The sacral screws provide bicorticle fixation in the sacrum to best resist the shear forces of recurrent spondylolisthesis

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The initial distraction is a critical step. If the spondylolisthesis reduces with the passive distraction, the surgeon may then proceed with placement of T-1 (The phase I Translation Plate) If the spondylolisthesis does not reduce with the passive distraction, the surgeon should proceed with placement of T-2 (The phase II Translation Plate) Surgical Technique

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Anatomic Reduction Persistent Spondylolisthesis T-1 T-2 Surgical Technique

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The T-2 Plate

ESM Technologies, LLC. : 

ESM Technologies, LLC. The Alignment Mill guide is placed centrally in the disc space. It must lie flush on the S-1 endplate. Cut will be perpendicular to end plate of S1 Alignment Mill Guide Surgical Technique for T-2

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The mill guide handle and shaft are removed and the end cutting burr is passed across the anterior aspect of S-1, machining the front of S-1 to receive the S-1 plate. Resultant cut is perpendicular the S-1 endplate Surgical Technique for T-2

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The S-1 plate is placed in the mill guide and transfixed to the sacrum with bicorticle fixation through the ala. S-1 Plate Mill Guide Surgical Technique for T-2

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The alignment pin is threaded into the S-1 plate. The Spondy plate is then placed into the disc space with the alignment pin passing through the corresponding reduction slot on the Spondy plate. Alignment Pin Spondy Plate Reduction slots on spondy plate x 2 Surgical Technique for T-2

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The L5 bone screws are placed stabilizing the spondy plate to L5. Alignment pin should be left in (Not Shown). The spondylolisthesis persists in an unreduced state. L5 Bone Screws x 2 Unreduced Surgical Technique for T-2

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The Reduction Instrument goes through the Spondy plate reduction slot into the S-1 plate and pulls the S-1 plate and S-1 vertebral body to the Spondy plate…Thus reducing the Spondylolisthesis Reduction instrument through reduction slot into S-1 plate Surgical Technique for T-2

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The Handle of the Reduction Tool is removed and the first Set Screw placed. Then the Reduction Tool is removed, followed by placement of the second Set Screw. The Spondy Plate and the S-1 plate are thus locked together with the Spondylolisthesis in the reduced position. Set Screw x 2 Surgical Technique for T-2

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The Interference Screws are placed followed by the Locking Plate Locking Plate Interference Screws x 4 Surgical Technique for T-2

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The Spondy Plate prevents back-out of the Sacral Screws through the S-1 plate while the Lock-out Plate prevents backout of the rest of the screws. Locking plate Spondy Plate prevents back-out of the Sacral Screws Surgical Technique for T-2

The Translation Plate System : 

The Translation Plate System Comprehensive System to address L5-S1 Spondylolisthesis from an anterior approach Unicortical or Bicortical fixation to the sacrum End plate and vertebral body fixation Address Deg. Disc Disease and Pseudoarthrosis from anterior approach Synergy with facet fixation