INTERSPINOUS STABILISATION

20 YEARS EXPERIENCE

Sami KHALIFE M.D.

AMIENS - FRANCE

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE

INTERSPINOUS STABILISATION
20 YEARS EXPERIENCE

Sami KHALIFE M.D.

AMIENS - FRANCE

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE

INTERSPINOUS STABILISATION
20 YEARS EXPERIENCE

Sami KHALIFE M.D

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - FRANCE

CATHEDRAL

The Cathedral of AMIENS Is the Largest GOTHIC STYLE Cathedral in France

JULES VERNE

A FAMOUS WRITER AND ADVANTURER AUTOR OF FICTION AND EXTRAORDIRARY TRAVELS

INTERSPINOUS STABILISATION

INTRODUCTION

Sami KHALIFE M.D.

AMIENS - FRANCE

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE

INTRODUCTION
DURING MANY DECENIES THE SOLUTIONS FOR DEGENERATIVE INSTABILITY OF LOMBAR SPINE WERE ARTHRODESIS, POSTEROLATERAL, ANTERIOR OR THE TWO COMBINED THE TECHNICAL DIFFICULTIES TO OBTAIN A STABLE FUSION THE COMPLICATIONS ASSOCIETED TO THAT HIGH RISK SURGERY THE DEGRADATION OF THE ADJACENT LEVELS TO ARTHRODESIS ON THE LONG RUN PUSHED THE SPINE SURGEONS TO LOOK FOR MORE CONSERVATIVE TECHNIQUES OF STABILISATION, EFFECTIVE, WITH LOW RISK AND ALLOWING ALL OTHERS SOLUTIONS POSSIBLE ON A NEXT STEP

Sami KHALIFE M.D.

AMIENS - FRANCE

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE

INTERSPINOUS STABILISATION
20 YEARS EXPERIENCE
CONCEPT AND EVOLUTION
DEVICES FLEXIS , ORIGINAL CONCEPT INDICATIONS AND LIMITS

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - FRANCE

INTERSPINOUS STABILISATION
20 YEARS EXPERIENCE
CONCEPT AND EVOLUTION
DEVICES FLEXIS , ORIGINAL CONCEPT INDICATIONS AND LIMITS

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - FRANCE

CONCEPT AND EVOLUTION

DISK DESEASE : Degenerative, traumatic or iatrogenic Is the most common cause of low back disorder ? Natural evolution leads to reduction of intersomatic space Reduction of the width of the foraminas Facet hyperpression syndrome Hyperthrophy and bulging of common posterior ligament Hyperthrophy and, bulging of the interlaminar ligament Reduction of the endocanalar space Anteroposterior and lateral instability Conflicts with nerves

Sami KHALIFE M.D.

AMIENS - FRANCE

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE

CONCEPT AND EVOLUTION

Sami KHALIFE M.D.

AMIENS - FRANCE

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE

THE SOLUTION ?
RESTORE THE ANATOMY BY DISTRATING THE INTERVERTEBRAL SPACE

DISTRACTION
RESTORE THE TENSION OF LIGAMENTS UND CAPSULES RESTORE THE HEIGH OF THE DISK DECREASE PRESSURE BETWEEN POSTERIOR FACETS INCREASE THE WIDTH OF THE CANAL INCREASE THE WIDTH OF THE FORAMINAS

INSURES BETTER STABILITY RELIEVES PAIN

INTERSPINOUS STABILISATION
20 YEARS EXPERIENCE
CONCEPT AND EVOLUTION
DEVICES INDICATIONS AND LIMITS FLEXIS , ORIGINAL CONCEPT

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - FRANCE

DEVICES

First no name Spacer

used from 1986 to 1997 (>500 cases)

Sami KHALIFE M.D.

AMIENS - FRANCE

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE

DEVICES Second spacer used Diam FROM 1997 to 2005 (365 cases)

Bone resorbtion and loss of correction with Diam after 16 monthes

CONDITIONS FOR A GOOD INTERSPINOUS DEVICE

DISTRACTION STABILITY MOBILITY

 THE GOAL IS A STABLE DEVICE WITH

LARGE AN LINEAR INTERFACE WITH SPINOUS PROCESSES TO PROTECT THEM WHEN INSURING A GOOD DISTRACTION FOR THE LONG RUN

AND IF YOU WANT TO PRESERVE SOME

MOBILITY, IT SHOULD BE IN THE DEVICE ITSELF

AND THE ORIGINAL IDEA WAS A MOBILE DISTRACTING DEVICE IN 3 ELEMENTS

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

INTERSPINOUS STABILISATION
20 YEARS EXPERIENCE
CONCEPT AND EVOLUTION
DEVICES FLEXIS , ORIGINAL CONCEPT INDICATIONS AND LIMITS

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - FRANCE

INTERSPINOUS STABILISATION

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - FRANCE

 FLEXIS DEVICE A NEW CONCEPT

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

 FLEXIS DEVICE A NEW CONCEPT

A DEVICE COMPOSED OF THREE ELEMENTS A SPINOUS ANCORAGE PIECE WITH A SPHERICAL INTERFACE ALLOWING LATERAL AND ANTEROPOSTERIOR MOBILITY A SPACER PIECE WITH DIFFERENT SIZES WITCH INSURE THE DISTRACTION A SPINOUS ANCORAGE PIECE WITH A CYLINDRICAL INTERFACE HAVING AN OBLONG HOLE ALLOWING TRANSLATIONS
Sami KHALIFE M.D.
SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

 FLEXIS DEVICE A NEW CONCEPT

WHEN THE THREE ELEMENTS OF THE DEVICE ARE ASSEMBLED THE COMBINATION OF THE INTERFACES ALLOWES A

3D MOBILITY

PRESERVES THE CONTACT ZONES BETWEEN SPINOUS PROSSESSES AND DEVICE, INSURING A GOOD STABILITY ON THE LONG RUN

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

 FLEXIS DEVICE MOBILITY

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS -F RANCE

MOBILITY

INTERSPINOUS STABILISATION

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - FRANCE

 FLEXIS DISTRACTION

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

INSTRUMENTATION

GAUGE CLAW

PIERCING CLAW

GRIP CLAW DISTRACTOR

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

ALLOWES THE CHOICE OF THE SIZE OF THE DITRACTION

DISTRACTOR

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

GRADUATION OF THE DISTRACTOR

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

SIZE GAUGES

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

 FLEXIS DISTRACTION

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

SURGICAL PROCEDURE

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - FRANCE

No for two reasons : If you do an endocanalar release You will have a better contrle for the distraction Musles and ligaments insure a good stability until the healing.

SHOULD YOU PRESERVE THE INTERSPINOUS LIGAMENT ?

Sami KHALIFE M.D.

AMIENS - FRANCE

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE

INSTALLATION OF THE PATIENT

INTERSPINOUS STABILISATION

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - FRANCE

GOUGE REGULARISATION

DISTRATOR INSERTION

INSERTION OF GABARIT

IMPLANT INSERTION

PERCING

FIXATION

DEVICE IN PLACE SECURED BY A NON RESORBABLE LIGAMENT

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

INPLANTATION IN MORE THAN ONE LEVEL

IF THE SPINOUS PROSSESS HAS A GOOD HEIGH THE IMPLANTATION OF TWO DEVICES IS EASY (LEFT) IF THE SPINOUS PROSSESS IS THIN YOU CAN EASILY CAT THE LATERAL FACETS OF ONE OR TOW ANCORAGE ELEMENTS TO ALLOW A GOOD POSITIONNING (UP)

INTERSPINOUS STABILISATION
20 YEARS EXPERIENCE
CONCEPT AND EVOLUTION
DEVICES FLEXIS , ORIGINAL CONCEPT INDICATIONS AND LIMITS

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - FRANCE

 FLEXIS DEVICE INDICATIONS

SYMPTOMATIC LOMBAR STENOSIS LOW BACK PAIN RESISTANT TO MORE THAN SIX MONTHES OF TRADITIONAL THERAPY PROTECTION OF THE ADJACENT SPACE TO AN ARTHRODESIS DYNAMIC INSTABILITY WITH A SLIPPING < 5 cm. RECCURENCE OF DISCAL HERNIA

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

LIMITS
LAMINECTOMIE SEVERE OSTEOPOROSIS SPONDYLOLISTESIS

Sami KHALIFE M.D.

SPINE SURGERY DEPARTMENT POLYCLINIQUE DE PICARDIE AMIENS - RANCE

Advantages of the FLEXIS

DISTRACTION : AS GOOD AS ALL OTHER DEVICES MOBILITY : AS GOOD AS OTHER DEVICES STABILITY : BETTER THAN ALL OTHER MOBILE DEVICES INSTRUMENTATION of L5-S1 SPACE

THE DAY OF MY FIRST FLEXIS