# ALIF/TLIF vs 360 Degree Lumbar Fusion...



## BCrandall (Apr 14, 2009)

Hey All,

One of my docs is questioning my coding on a 360 fusion. He's documenting an anterior mini-retroperitoneal approach for fusion along with a straightforward posterior lumbar fusion. Is this a 360? 

I always thought a 360 was when the anterior fusion was done and the patient was physically flipped (as opposed to turning them on their side for a TLIF) then the posterior fusion was done or vice-versa. 



If I'm right I get to watch one being performed, otherwise I have to re-bill and make him a dictation template...


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## RebeccaWoodward* (Apr 14, 2009)

*There seems to be lots of confusion regarding 360° fusions. Would you please clarify the clinical components that constitute a 360° spinal fusion? *

Clinically, a 360 spinal fusion is an anterior and posterior fusion of a vertebra performed during the same operative session.  There are two ways to accomplish a 360 fusion.  In the conventional one, an incision is made in the patient's front (abdominal region) to do the anterior fusion, then the patient is flipped over and a second incision is made in the back to do the posterior fusion.  The second method is a single incision approach, where both the anterior and posterior faces of the vertebra are reached through one incision.  Depending on the patient's clinical situation, this single incision can be either posterior or transforaminal but not anterior.

A 360° spinal fusion requires that both the front and back of the vertebra be fused.  Fusion is a "welding" process by which two or more vertebrae are fused together with bone grafts, a bone equivalent, or a bone substitute into a single solid bone.  In a 360 fusion, bone or bone substitutes are placed between the vertebrae to promote the anterior fusion.  Then for the posterior fusion, bone is laid along the transverse processes of the vertebrae; this is sometimes called laying bone "in the gutters".  Alternately, some surgeons accomplish the posterior fusion by "roughing up" the facets and then laying the resulting bone chips posteriorly.

Spinal instrumentation, like screws and rods and plates, is almost always used posteriorly as well.  Just note that the instrumentation is used for fixation and stability, not fusion per se.  Regardless of the instrumentation, it's the use of bone grafts or chips, a bone equivalent, or a bone substitute that actually constitutes the fusion.  For a 360 fusion, these bone devices must be used both front and back, with or without instrumentation. 

http://www.sofamordanek.com/spineline/physician/faqs.html#360


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## BCrandall (Apr 14, 2009)

Thanks Rebecca, that's EXACTLY what I need!


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## RebeccaWoodward* (Apr 14, 2009)

I've gotta admit...I'm rather jealous. I've wanted to sit on a spine surgery for some time...hasn't happened yet.  Good luck to you~


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## BCrandall (Apr 15, 2009)

I still have hoops to jump through (HIPPA, waivers and such) butI look forward to seeing something live as opposed to you-tube...


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