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Physical Medicine and Rehabilitation

 

Information for Patients


Anterior lumbar interbody fusion (ALIF)

Anterior Lumbar Interbody Fusion (ALIF) is a common fusion procedure similar to PLIF, however it is done from the front (anterior) of the body, usually through a three to five inch incision in the lower left abdominal area. This incision may involve cutting through, and later repairing, the muscles in the lower abdomen. A mini open ALIF approach is available that preserves the muscles and allows access to the front of the spine through a very small incision. This approach maintains abdominal muscle strength and function and is oftentimes used to fuse disc space. Once the incision is made and the vertebrae are accessed, and after the abdominal muscles and blood vessels have been retracted, the disc material is removed. The surgeon then inserts bone graft (and anterior interbody cages, rods, or screws if necessary) to stabilized the spine and facilitate fusion.
For a brief video, click here on how this procedure is performed, click here (this link will redirect you to a non-UCD website)

Endoscopic discectomy

The endoscopic discectomy procedure is performed through a small tube placed through a small puncture in the skin. A specialized micro video camera, or a microscope and specialized lighting, is used to visualize the nerves and disc. Removal of disc material is performed with specialized micro instruments.
The benefit of this procedure lies in the reduction of local trauma. Specifically, this means that none of the muscles, ligaments, or other soft tissue structures have been cut or disrupted in anyway. This translates into very little pain after surgery and a greatly enhanced rate of recovery. This technique can often be done on an outpatient basis and many patients can return to work in just a few days.

This technique is only appropriate for certain types of disc herniations.

Endoscopic lumbar interbody fusion

New and evolving technologies now allow us to perform lumbar interbody fusion surgery via the endoscopic approach. The endoscopic approach is most appropriate for spine conditions affecting one level. The endoscopic approach to lumbar interbody fusion can be done through several small punctures in the skin. The endoscopic approach requires a small incision that is considerably smaller and less traumatic than the traditional open approach.

The endoscopic approach can reduce the patient's hospital stay to one or two days. Postoperative pain is dramatically reduced and overall function is dramatically improved. Return to work and play can be greatly accelerated by utilizing this technique

eXtreme Lateral Interbody Fusion (XLIF)

The XLIF® (eXtreme Lateral Interbody Fusion) procedure provides relief to patients who cannot tolerate a larger, open back surgery because of the increased risks of longer anesthesia time, blood loss, hospitalization, and recovery. It is also a less invasive alternative for patients who have lived with back or leg pain through years of various failed treatments, including steroid injections, physical therapy, and pain medication.

The XLIF® procedure includes the use of NeuroVision®, a technologically advanced nerve monitoring system (EMG), allows the surgeon to have accurate, reproducible, real-time feedback about nerve health, location, and function, reducing the incidence of nerve injury during surgery. Read more about NeuroVision and the importance of nerve monitoring.

Patient Benefits:

  • Reduced operative time
  • Traditional procedures can take up to 5 hours; the XLIF procedure can be successfully completed in as little as one hour, reducing the amount of anesthesia time.
  • Reduced blood loss and minimal scarring
  • Less-invasive procedure allows for less tissue disruption, resulting in reduced blood loss.
  • Reduced postoperative pain
  • The XLIF procedure does not require entry through sensitive back muscles, bones, or ligaments.Many patients are usually walking the same day after surgery.
  • Reduced hospital stay
  • Patients are typically walking the same day after surgery and require only an overnight stay in the hospital, compared to several days of immobility and hospitalization typical of traditional open approaches
  • Rapid return to normal activity
  • Patients are usually walking the same day after surgery. Recovery is typically around 6 weeks, compared to 6 months or more.


  • For more information about the XLIF procedure please visit lateralaccess.org

Minimal access spinal surgery

Several types of spinal procedures are routinely done utilizing minimal access techniques. The development of these techniques is now being applied to fusion surgeries.

Minimally invasive spine surgery

Minimally invasive spine surgery allows the surgeon to make smaller incisions in the skin and avoid large muscle retraction. The surgeon uses a scope inserted through a small incision. A tiny video camera and light are connected to the scope and send images from inside the body to a screen in the operating room. Small tubes are then inserted through other small incisions and surgical instruments are inserted through these tubes and used to perform the procedure.

Advantages:

  • Reduced operative times
  • Less soft tissue and muscle damage
  • Reduced blood loss
  • Quicker recovery
  • Shorter hospital stay

Posterior lumbar interbody fusion (PLIF)

Posterior Lumbar Interbody Fusion (PLIF) is a common fusion technique, where the vertebrae are reached through an incision in the patient's back (posterior). The PLIF procedure involves three basic steps:

  • Pre-operative planning and templating. Before the surgery, the surgeon uses MRI and CAT scans to determine the size of implant(s) the patient needs.
  • Preparing the disc space. Depending on the number of levels to be fused, a three to six inch incision is made in the patient's back and the spinal muscles are retracted (or separated) to allow access to the vertebral disc. The surgeon then carefully removes the lamina (laminectomy) to be able to see and access the nerve roots. The facet joints, which lie directly over the nerve roots, may be trimmed to allow more room for the nerve roots. The surgeon then removes some or all of the affected disc and surrounding tissue.
  • Implants are then inserted. Once the disc space is prepared, a bone graft is inserted into the disc space to promote fusion between the vertebrae. Additional instrumentation (such as rods or screws) may also be used at this time to further stabilize the spine.

Spine fusion

Spinal fusion is a surgical procedure in which two or more vertebrae are joined or fused together. Fusion surgeries typically require the use of bone graft to facilitate fusion. This involves taking small amounts of bone from the patient's pelvic bone (autograft), or from a donor (allograft), and then packing it between the vertebrae in order to fuse them together. This bone graft, along with a biomechanical spacer implant, will take the place of the intervertebral disc which is entirely removed in the process. Spinal fusion surgery is a common treatment for such spinal disorders as spondylolisthesis, scoliosis, severe disc degeneration, or spinal fractures. Fusion surgery is usually considered only after extensive non-operative therapies have failed.

Post Fusion Surgery Recovery time is different for every patient, however, most patients are up and walking by the end of the first day after surgery. Most patients can expect to stay in the hospital for 3-5 days depending on their condition.

Transforaminal lumbar interbody fusion (TLIF)

Transforaminal Lumbar Interbody Fusion (TLIF) recently gained popularity as a surgical treatment for conditions affecting the lumbar spine. The TLIF technique involves approaching the spine but more from the side of the spinal canal through a midline incision in the patient's back. This approach greatly reduces the amount of surgical muscle dissection and minimizes the nerve manipulation required to access the vertebrae, discs and nerves. The disc material is removed from the spine and replaced with bone graft (along with cages, screws, or rods if necessary) inserted into the disc space. The instrumentation helps facilitate fusion while adding strength and stability to the spine.