Minimally Invasive Spinal Fusion

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Minimally Invasive Spinal Fusion is a procedure performed to alleviate the pressure on the lumbar spinal nerves as a result of lumbar disc herniations or other degenerative conditions. When an intervertebral disc becomes herniated the gelatinous disc nucleus material (nucleus pulpous) is forced out from the disc. This herniated disc material then enters the spinal canal where it begins to press against the spinal cord or spinal nerves. This often causes pain both in the area of the herniation as well as pain in the back, buttocks, legs or feet. Removing the disc and any bone spurs will alleviate the pressure on the nerves or spinal cord, which relieves the pain.

The type of approach (ALIF, PLIF, TLIF, XLIF) will vary based on your condition and it is best to discuss with your surgeon which of these procedures may be right for you. All of these approaches are carried out through a Minimally Invasive technique and serve to alleviate spinal conditions and radicular pain.

Minimally Invasive Approach
In this procedure, a small incision is made in the lumbar spine, depending upon the location of the disc(s). Using a muscle-sparing technique, small surgical instruments and a surgical camera are slipped between the muscle fibers and onto the offending spinal disc(s). Specialized instruments are used to remove the herniated disc or bone spurs entirely and the surgeon is able to visualize the spine real-time using a fluoroscope. After disc material is removed, a bone graft is placed in the empty disc space. Over time, this bone graft will knit together with the vertebrae above and below to form one larger and more stable vertebra.

A small stabilization plate and surgical screws are also placed between the vertebrae to provide stability to the spine as well as ensure the bone graft maintains its proper position.

Many people with chronic back pain have avoided Spinal Fusion surgery due to the perceived lack of mobility and lengthy recovery time associated with Spinal Fusion procedures. However, with New Jersey Spinal Medicine and Surgery’s Minimally Invasive Techniques, lengthy recoveries are avoided and spinal mobility is maintained.

About Minimally Invasive Fusion Procedures
Anterior Lumbar Interbody Fusion Approach (ALIF)

Many spinal surgeries are performed posteriorly (from the back); however, the surgeon may choose an anterior approach for lumbar interbody fusion for a variety of reasons, including:

  • To gain better access to the intervertebral disc
  • To avoid the possibility of multiple surgeries in the same area (if spinal surgery has already been performed, or if it is planned in the future)

The surgeon will enter the spine through a small incision in the left lower abdomen. As a result of rectus abdominis (anterior abdominal) muscle being a vertical muscle, it is not necessary to cut this muscle as it can be easily moved to the side.  Using this muscle-sparing technique, small surgical instruments and a surgical camera are slipped between the muscle fibers and onto the offending spinal disc(s). Specialized instruments are used to remove the herniated disc or bone spurs entirely and the surgeon is able to visualize the spine real-time using a fluoroscope.

After disc material is removed, a bone graft is placed in the empty disc space. Over time, this bone graft will knit together with the vertebrae above and below to form one larger and more stable vertebra.

A small stabilization plate and surgical screws are sometimes placed between the vertebrae to provide stability to the spine as well as ensure the bone graft maintains its proper position.

Many people with chronic back pain have avoided Spinal Fusion surgery due to the perceived lack of mobility and lengthy recovery time associated with Spinal Fusion procedures. However, with New Jersey Spinal Medicine and Surgery’s Minimally Invasive Techniques, lengthy recoveries are avoided and spinal mobility is maintained.

Transforaminal Lumbar Interbody Fusion (TLIF)

Transforaminal Lumbar Interbody Fusion (TLIF)

This Minimally Invasive procedure is performed to alleviate the pressure on the lumbar spinal nerves as a result of lumbar disc herniations or other degenerative conditions. When an intervertebral disc becomes herniated the gelatinous disc nucleus material (nucleus pulposus) is forced out from the disc. This herniated disc material then enters the spinal canal where it begins to press against the spinal cord or spinal nerves. This often causes pain both in the area of the herniation as well as pain in the back, buttocks, legs or feet. Removing the disc and any bone spurs will alleviate the pressure on the nerves or spinal cord, which relieves the pain.

Transforaminal Lumbar Interbody Fusion Approach

A transforaminal lumbar interbody fusion is performed to fuse together the front and back part of the vertebral body from a single posterior approach.  After the incision is made, the lamina (a piece of bone over the spinal canal) is removed to get better visualization of the spine. Next, any nerve roots are moved to the side and the disc or bony material is cleaned out of the disc space.  After disc material is removed, a bone graft is placed in the empty disc space. The front part of the spine is then stabilized by a spacer and bone graft.  The bone graft is then placed into the interbody space along the back of the vertebra. This bone graft, over time, will fuse to the bones in the vertebrae and stabilize them. The back part of the spine is set with the bone graft, screws, and rods.   Hardware (rods and screws) are usually placed to help the rate of fusion.   The screws and rods are placed on the back of the bone and a spacer is placed into the intervertebral disc space on one side.

Posterior Lumbar Interbody Fusion (PLIF)

Posterior Lumbar Interbody Fusion (PLIF)

This Minimally Invasive procedure is performed to alleviate the pressure on the lumbar spinal nerves as a result of lumbar disc herniations or other degenerative conditions. When an intervertebral disc becomes herniated the gelatinous disc nucleus material (nucleus pulposus) is forced out from the disc. This herniated disc material then enters the spinal canal where it begins to press against the spinal cord or spinal nerves. This often causes pain both in the area of the herniation as well as pain in the back, buttocks, legs or feet. Removing the disc and any bone spurs will alleviate the pressure on the nerves or spinal cord, which relieves the pain. The posterior lumbar interbody fusion procedure involves placing bone graft into the unstable disc spaces in the back.  The purpose of the bone graft is to get a biological response that will cause bone to grow in between the vertebrae, connecting them together.

Posterior Lumbar Interbody Fusion Approach

“Posterior” means that the surgical incision is made from the back.  The size of the incision will depend on how many vertebra need to be fused. First, an incision is made directly over the site in the midline of the back.  The lower back muscles are then carefully retracted to the side.  The lamina (a piece of bone over the  spinal canal) is then removed  to get better visualization of the spine. Next, any nerve roots are moved to the side and the disc or bony material is cleaned out of the disc space.  After disc material is removed, a bone graft is placed in the empty disc space. Over time, this bone graft will knit together with the vertebrae above and below to form one larger and more stable vertebra. A small stabilization rod and surgical screws are also placed between the vertebrae to provide stability to the spine as well as ensure the bone graft maintains its proper position.

Extreme Lateral Interbody Fusion (XLIF)

Extreme Lateral Interbody Fusion (XLIF)

This Minimally Invasive procedure is performed to alleviate the pressure on the lumbar spinal nerves as a result of lumbar disc herniations or other degenerative conditions. When an intervertebral disc becomes herniated the gelatinous disc nucleus material (nucleus pulposus) is forced out from the disc. This herniated disc material then enters the spinal canal where it begins to press against the spinal cord or spinal nerves. This often causes pain both in the area of the herniation as well as pain in the back, buttocks, legs or feet. Removing the disc and any bone spurs will alleviate the pressure on the nerves or spinal cord, which relieves the pain.

An extreme lateral interbody fusion is a procedure that is performed by the surgeon going into the spine through a lateral (side) incision, rather than the more traditional anterior (front) or posterior (back) approaches.  The XLIF procedure can only be performed in the upper lumbar vertebrae.  It cannot be performed for conditions involving L5-S1.

The extreme lateral interbody fusion is a minimally invasive procedure with several advantages including that it creates very minimal tissue damage, has less blood loss, and smaller incisions are required.  Since this is an interbody fusion, the disc in the front of the spine is removed and replaced by a prosthetic implant made of bone graft or synthetic material.  This will allow the vertebrae to fuse together as one through the disc space.   

Extreme Lateral Interbody Fusion Approach

The XLIF procedure is performed in a series of steps.  After localizing with fluoroscopy, an incision is made on the patient’s side, where a dilator (tube instrument) is placed and then x-rayed to ensure it is in a good position.  A probe is placed between the psoas muscle running from the lower spine.  The surgeon receives real-time information about the position of the probe with respect to the nerves that run near and around the psoas muscle.

Next,  a standard discectomy (removal of the disc) is performed and the implant is placed in the now vacant intervertebral disc space (space between the vertebra).  A cage, or spacer, made up of bone graft or synthetic material is placed to hold the bones in the proper position, as well as to make sure the disc height is correct and the spine is well aligned.  



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