1.
Direct Lateral Interbody Fusion
About 20 consecutive cases
with Ursus cage by SYNTROPIQ
Dr M. Triffaux
Department of Neurosurgery
CHwapi Tournai Belgium
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Arosa 2023 6th NSpine Winter Masterclass 19.01.2023
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2.
The Anterior Approach
The advantages of the anterior:
• A restoration of local lordosis
• To place a large implant
LLIF
• A mini open surgery
• A less blood loss
• Preservation of paraspinal muscles
• Decreased hospital stay
• Improved recovery
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3.
The Lateral Approach
DLIF, eXLIF, (OLIF)
The advantages of the lateral:
• The same of anterior
• ALL et PLL conservation
• Short operative time: 30’/level
• An avoidance of sacral plexus
• A minimal risk to vascular vessels
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The Direct Lateral Approach
A disadvantage: the lumbar plexus
Uribe JS, Arredondo N, Dakwar E, Vale FL (2010)
Defining the safe working zones using the minimally
invasive lateral retroperitoneal transpsoas
approach: an anatomical study. J Neu- rosurg Spine
13(2):260–266
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=> Neuro monitoring
The Direct Lateral Approach
A disadvantage: the lumbar plexus
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The DLIF or eXLIF
A meticulous positioning
of the patient and of the fluoroscopy
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What do you want obtain ?
A solid stabilization construct
with a good indirect decompression
with an increase lordosis
with a coronal correction
with a solid bone union
And first of all a good outcome
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What does it take to fuse ?
A good surgical technique
A good patient: bone density, non-smoker, …
A good knowledge of bone formation
A good device
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The cage for DLIF/ eXLIF
Different materials:
PEEK: alone / PEEK coated Ti
Titanium: Trabecular / 3D printing
Activated Ti / ….
Different designs
with a large window for the bone graft
expandable cage
Different contact surface:
macro, micro , nano asperities
Different angle of lordosis 9

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The cage for DLIF/ eXLIF
Different bone graft or substitute
autograft
allograft chips, powder
bone substitute
Bone Morphogenic Protein
Platelet Rich Plasma Activated
…
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The cage for DLIF/ eXLIF
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over 70 different cages

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The knowledge of bone fusion
Schematic representation of a Basic Multicellular Units and the associated bone remodeling process
(*).
(*) Cellular and Molecular Mechanisms of Bone Remodeling
Liza J. Raggatt and Nicola C. Partridge, THE JOURNAL OF BIOLOGICAL CHEMISTRY VOL. 285, NO. 33, pp. 25103–25108, August 13, 2010
(**) Mechanical Signaling for Bone Modeling and Remodeling.
Alexander G. Robling and Charles H. Turner, Crit Rev Eukaryot Gene Expr. 2009 ; 19(4): 319–338. 12

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Bone fusion a dynamic process
… Mechanical stimulation and the endocrine signal PTH can
exert and enhance bone formation signals via osteocytes (*).
… Mechanical loading is a simple yet effective way to increase
bone mass, decrease bone loss, and improve bone strength
(**).
Based on the in vitro results, a functional graded scaffold is
suggested which combines small pores for initial cell
attachment and larger non-circular pores to avoid pore
occlusion
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Syntropiq Dynamic Contact Surface
Endplate
Syntropiq DCS
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Syntropiq Dynamic Contact Surface
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X20 X100 X3000
Macro , micro , nanometric asperities

16.
Syntropiq Dynamic Contact Surface
Finite Elements (FEM) Study to
define load distribution as
function of geometrical relations
Study performed at Department of Biomechanics, University of Technology in Wroclaw
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Fluoroscopic evaluation of new bone cells colonisation factor, Eclipse 80i
Study performed at Department of Biomechanics, University of Technology in Wroclaw
A biological test assessing the
dynamics of bone growth
In accordance to ISO 10993-5:2009
Also in biological test
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Ursus cage 3D printing
Multispiked Contact Area of DCS ™
Syntropiq DCS Area
Subsiding Zone for DCS ™
Subsiding Zone
Vertebral Endplate
Vertebral Endplate
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Ursus cage 3D printing
Multispiked Contact Area of DCS ™
Unique Three Dimensional Design of Syntropiq Dynamic Contact Surface
distributes Isotropically Physiological Loads and Contributes Proactively in
Acceleration of Bone Ingrow Process
Anterior Profile
Lateral
Profile
Vertebral Endplates
Teasing Points Area
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Ursus cage 3D printing
Syntropiq DCS employs Controlled Subsiding Process and by following the
Cellular Mechanism of Bone Remodeling*) initiates Bone Cells Reversal Process
By engaging Wolf’s Law accelerates Growing Process of New Bone Structures
(*) Cellular and Molecular Mechanisms of Bone Remodeling. Liza J. Raggatt and Nicola C. PartridgeTHE JOURNAL OF BIOLOGICAL CHEMISTRY VOL. 285, NO. 33, pp. 25103–25108, August 13, 2010
(**) Mechanical Signaling for Bone Modeling and Remodeling. Alexander G. Robling and Charles H. Turner, Crit Rev Eukaryot Gene Expr. 2009 ; 19(4): 319–338.
Activation
Controlled Subsiding Resorption Reversal Formation Fusion
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The Syntropiq cage family
Aries
Perseus
Taurus
Andromeda
Ursus 21

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And in the reality
20 consecutive cases Preliminary Study
Dr Marouane Makhchoune Dr Michel Triffaux
Retrospective study 01/2020-04/2021
20 consecutive DLIF with lateral fixation
Demographic: mean age 62,5
9 men 11 females
Rx measurements: foraminal height, disc height,
lumbar lordotic angle, lumbar
coronal angle, subsidence 22

23.
In the reality
20 consecutive cases Preliminary Study
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Demographic data
N 20
Sex ratio (M/F) 09/11
Operative sites
1 level L1-L2 1
L2-L3 3
L3-L4 4
L4-L5 5
2 levels L1-2-3 0
L2-3-4 3
L3-L4-L5 2
3 levels L1-2-3-4 1
L2-3-4-5 1
Total 29

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Preoperative Postoperative
Lumbar lordotic angle 42,1° 43,2°
Foramen height (mm) 17,12 19,91
Lummbar coronal angle 5,35° 2°92°
Disc height (mm) 8,29 10,79
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In the reality
20 consecutive cases Preliminary Study
Subsidence Patients (%) Levels (%) Means (mm)
Total 7 /20 (35) 7/29 (24) 6,27
2-3 mm 1/20 (5) 1/29 (3) 2,4
> 3 mm 6/20 (30) 6/29 (21) 6,9

25.
In the reality
20 consecutive cases Preliminary Study

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In the reality
20 consecutive cases Preliminary Study

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In the reality
20 consecutive cases Preliminary Study
Preliminary result
The data is not yet complete
the fusion rate is not yet known
the clinical data is not yet analyzed
no revision required at this time
No systematic osteodensitometry

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Thanks to Motion team
Thanks Greg