Lumbar spinal fusion is a common technique to help
patients with back pain, who have failed non-operative treatment. Once you and
your physician have decided that you need fusion of your lumbar spine, you
should realize that there are many different ways this procedure can be done.
The choice of which technique is best for you is dependent on what is wrong
with your spine. Your surgeon may have more experience with fusion techniques
from the front of the spine (anterior), the back of the spine (posterior), or
some of the newer, less invasive approaches. These newer techniques are often
called Minimally Invasive Spinal (MIS) surgery. The goals of all these
techniques remain the same, to achieve a lumbar fusion, and lessen the
patient's pain.
The most common method of spinal fusion involves the
posterior approach, with an incision along the back of the patient's spine.
Often, this procedure is used if bone spurs, thickened ligaments, or disc
ruptures need to be removed to alleviate pressure on the nerves. The fusion
procedure then involves placement of metal screws, rods and bone graft.
Anterior spinal fusions require an incision through the abdomen. After removal
of the degenerated disc, a metal cage with bone graft is usually placed between
the spinal bones (vertebral bodies). Some patients will require both front and
back procedures.
There are many new surgical techniques that are being
developed to improve the results of lumbar fusions. Minimally invasive spine
surgery for lumbar fusion is one of these newer techniques. MIS procedures have
smaller incisions, cause less trauma to the surrounding normal tissues, and
hopefully results in a faster recovery for the patient. One of these MIS
techniques is a procedure known as extreme-lateral lumbar interbody fusion (XLIF).
During the XLIF procedure the lumbar spine is approached from the side through
a small skin incision. The surgery is performed through a muscle that lies next
to the lumbar spine known as the psoas muscle.
With the XLIF procedure, approximately 2/3 of the disc
can be safely removed. After the disc is removed, an artificial graft is placed
in between the vertebrae, to allow the bones to fuse together. For a single
level XLIF procedure, the surgery can be usually be performed in about an hour.
Most patients stay in the hospital for 24 hours following the procedure, and do
not require a brace. Occasionally, weakness may be noticed while lifting your
leg after surgery. This psoas muscle weakness should return to normal fairly
soon after surgery.
Not everyone is a candidate for this surgery, once
conservative (non-operative) treatments have failed, you should consult a
surgeon to see if you are an appropriate candidate.
The major advantage of all of
these minimally invasive techniques is that there is less damage caused to the
surrounding tissues. Unfortunately, in traditional spinal surgery it is
necessary to cut through muscles and move them out of the way in order to reach
the spine. This can cause a large amount of pain following surgery, and it can
lengthen the recovery time. Instead of cutting and moving muscles, the
minimally invasive techniques can more gently spread through the muscles to
allow access to the spine. This is much less painful for the patient, and it
does not require as long of a recovery period for the muscle to heal.
Another
benefit of less muscle damage is less blood loss and thus a reduced need for
blood transfusions using the minimally invasive techniques. There is often less
need for narcotic pain medications following this form of surgery, and a
shorter hospital stay.
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