If the spinal arthritis has progressed to spinal instability,
the patient may require a combination of lumbar decompression (laminectomy) and
lumbar fusion to stabilize the spine and alleviate chronic back pain. Lumbar
fusion, also called spinal fusion. Fusion may also involve supplemental hardware, such as plates, cages, and
screws to hold the spine in place. Once the union between the vertebrae has
solidified, the hardware is no longer needed, but few patients are eager to
undergo another surgery for their removal.
Lumbar fusion can be performed using the traditional open
technique or minimally invasive methods. In traditional open spinal fusion
surgery, the surgeon must make a large incision and cut through thick spinal
muscles.
Spinal fusion procedures involve removing the disc from between
the vertebrae (in the disc space) and then filling the gap with a metal,
plastic, or bone spacer. These spacers, also called cages, contain bone graft
material that facilitates bone healing and fusion. After the spacer is implanted,
the surgeon may use metal screws, plates, and rods to further stabilize the
spine.
About 80 percent of all fusion surgeries involve one or two
levels of vertebrae of the spine. Patients undergoing this type of fusion are
very likely to be able to return to their normal activities after the surgery.
The experienced physicians at Midwest Orthopaedics at Rush
Minimally Invasive Spine Institute may recommend spinal fusion to alleviate
symptoms for many back conditions, including:
- Tumor
- Spinal stenosis
- Spondylolisthesis
- Fracture
- Scoliosis
- Degenerative Back Disease
Lumbar fusion can be performed from the front (anterior
approach), from the back (posterior approach) or from the side (lateral
approach). The surgeons at Midwest Orthopaedic at Rush Minimally Invasive Spine
Institute choose which approach is most appropriate based upon many factors,
including the need for bone spur removal, the degree of instability, the
medical condition, and body habitus of the patient. Usually the decision as to
which approach makes the most sense involves a discussion of the pros and cons
of each approach in a particular situation. The following are spinal fusion
approaches that may be considered:
- Anterior
Lumbar Interbody Fusion (ALIF) with Instrumentation
- Posterior
Lumbar Interbody Fusion (PLIF)
- Transforaminal
Lumbar Interbody Fusion (TLIF)
- Lateral
Fusion Interbody Fusion (XLIF, DLIF)
Anterior Lumbar Interbody Fusion (ALIF) with Instrumentation: ALIF is used in the
treatment of a disc problem that causes pain and instability in the lower back
(lumbar spine). In ALIF, the procedure is performed from the front allowing to access the spine without moving nerves and disturbing
the back muscles.
Posterior Lumbar Interbody Fusion (PLIF): In PLIF, the
surgeon approaches from the back by making one or two 2.5 cm incisions that
provide access to the spine once the lamina (bone) is removed and nerves are
retracted. In addition to spinal stenosis, PLIF is common in treating patients
with:
- Spondylolisthesis
- Degenerative Disc Disease
- Recurring Herniated Disc
Transforaminal Lumbar Interbody Fusion (TLIF): In TLIF, use the posterior (back) approach or the lateral (side)
approach. The surgery is performed on one side only and the bone graft is
inserted into the disc space laterally. The facet joints may be trimmed or
removed to give nerve roots room. This approach requires less movement of
nerves and opening of back muscles. The incision is 2 cm in length. In addition
to spinal stenosis, TLIF is common in treating patients with:
- Spondylolisthesis
- Degenerative Disc Disease
- Recurring Herniated Disc
Lateral Interbody Fusion (XLIF/DLIF): These procedures, which helped to develop,
are being used to treat patients with spinal instability caused by degenerative
discs, loss of height of disc space that causes pinching of a spinal nerve,
change in normal curvature to the spine (scoliosis), and slippage of one
vertebra over another. These procedures make use of the side (lateral) approach
avoiding the spinal muscles and may take about one to one and a half hours to
complete.
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