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What is Lumbar Interbody Fusion?

Lumbar interbody fusion (LIF) surgery is a surgical technique that involves the removal of a damaged intervertebral disc and the insertion of a bone graft into the disc space created between the two adjoining vertebrae. Bone grafts promote healing and facilitate fusion. Screws and rods are used to stabilize the spine during the healing process.

Indications for Lumbar Interbody Fusion

Lumbar interbody fusion (LIF) surgery may be recommended for degenerative disc disease, spondylolisthesis, and disc herniation. The aim of the surgery is to alleviate back or leg pain and stabilize the spine.

Types of Lumbar Interbody Fusion

An interbody fusion can be performed with different approaches, which include: Anterior lumbar interbody fusion (ALIF): In this technique, the spine is approached from the front by making an incision over the abdomen. Posterior lumbar interbody fusion (PLIF): Your surgeon gains access to the spinal canal, disc and nerve roots from the back. In this procedure, the lamina is removed and the facet joints are trimmed to gain access to your spine. Transforaminal lumbar interbody fusion (TLIF): In this technique, the spine is approached from the side. This allows your surgeon to access the front as well as the back of your spine. Direct lateral interbody fusion (DLIF): In this approach, the spine is also approached from the side. Using a minimally invasive technique, the underlying soft tissues and the psoas muscle are gently separated to reach the intervertebral disc. As the spine is approached through the psoas muscle, DLIF is also known as the trans-psoas approach.

Before Lumbar Interbody Fusion

Before surgery, your doctor will discuss the type of procedure as well as its associated risks and benefits. Your doctor may also recommend a few blood tests, X-rays or other imaging tests to evaluate your medical condition.

Lumbar Interbody Fusion Procedure

  • Lumbar interbody fusion may be performed using a minimally invasive technique, under general anesthesia with the assistance of X-ray or fluoroscopic guidance.
  • Your surgeon may approach your spine from the back, abdomen or neck, depending on the area to be treated.
  • During the surgery, your surgeon performs a discectomy, where a portion of the diseased or damaged disc material is removed. Next, a laminectomy is performed. The roof of the vertebra will be trimmed or removed to relieve pressure on the nerve.
  • Following laminectomy, the bone graft (small chips of bone) will be placed between the vertebrae. Screws and rods are placed into the vertebrae to support the graft and promote the fusion of the vertebrae.

After Lumbar Interbody Fusion

Following lumbar interbody fusion, you will be shifted to the recovery room to closely monitor your vital signs. Minor discomfort, pain at the incision site, muscle spasms in the neck or back, or other related symptoms may be present after the surgery. You may need to wear a lumbar brace to support the spine during the healing process.

Postoperative Care following Lumbar Interbody Fusion

You will need to keep the incision area clean and dry. Do not swim or use hot tubs. Also avoid driving, smoking and lifting heavy objects. You can begin physical therapy as directed by your surgeon. You should take medications as prescribed by your surgeon and schedule a timely follow-up.

Risks and Complications of Lumbar Interbody Fusion

Infection, bleeding, nerve injury, and problems with anesthesia are the potential risks and complications associated with lumbar interbody fusion (LIF) surgery. If you develop any signs of infection such as pain, redness, swelling or alteration in the quantity or smell of the drainage, or fever over 101°F, you should immediately call your doctor. Also, inform your doctor if you develop bowel and bladder dysfunction or numbness over the genital area.

XLIF - Extreme Lateral Interbody Fusion

Extreme lateral interbody fusion (XLIF) is a minimally-invasive surgery that involves the fusing of two degenerative spinal vertebrae. The procedure is conducted to relieve painful motion in the back caused by spinal disorders.

Spinal problems occur primarily between vertebrae, where they are packed with a cushioning material called an intervertebral disc. Over the years, the discs undergo wear and tear, allowing the vertebrae to painfully rub against each other when we move, and they degenerate.

The fusing of degenerated vertebrae maintains the optimal disc space between them, aligns and stabilizes the spine, and protects the spinal cord and nerves from further damage.

Indications

XLIF is considered when the patient does not respond well to pain killers, physical therapy, and steroid injections. It is indicated for leg and back pain that is caused by any of the lumbar or lower spine disorders listed below.

  • Degenerative disc disease (damaged discs between two vertebrae)
  • Degenerative scoliosis (sideways curve of spine)
  • Degenerative spondylolisthesis (one vertebra moves away from the normal spine alignment)
  • Recurring disc herniation (ruptured disc)
  • Posterior pseudoarthrosis (previous failed fusion surgery)
  • Post-laminectomy syndrome (spinal instability following non-fusion surgery)
  • Adjacent level syndrome (a condition that occurs next to previous fusion surgery)

Contraindications

XLIF may not be an option for the following conditions:

  • Degenerative spondylolisthesis of greater than grade 2
  • Presence of scarring behind the abdominal cavity, on either side of the spine as a result of previous surgery or abscess

Procedure

XLIF adopts a lateral approach when compared to traditional methods of spinal fusion techniques, and in doing so, spares the disruption of major back muscles, ligaments, and bones. Since the procedure is done in close proximity with several important nerves in the spinal column, your surgeon will continuously monitor them with electromyography (EMG) to avoid any damage to the nerves.

The surgery takes about one hour and is performed under general anesthesia. You will be positioned onto one side. Using X-ray, your surgeon will locate and mark off the affected region. Through a small incision made in your back, your surgeon will hold back the peritoneum (outer covering of abdominal organs) and will make a second incision on your side for instruments called tubular dilators to pass through. The affected disc is then removed, and replaced with an implant filled with bone graft, which will aid in the fusion of the adjacent vertebrae. The instruments are removed and incision stitched and bandaged. Additional support with the help of plates, rods, or screws may be inserted.

Recovery

XLIF ensures a quick recovery and lets you return to normal activities. As this approach does not damage muscles, ideally you will be able to walk the evening of the surgery and will be discharged the next day. Following your discharge, you will be prescribed medication for pain.

Risks and complications

The surgery may be associated with infection, damage to nerves, spinal cord or blood vessels, muscle weakness, and enduring pain at the site of bone graft. There are chances of the implant failing to fuse the vertebrae and a progression in the existing disease. Other conditions such as deep vein thrombosis or clotting, urinary tract infection, stroke, and pneumonia may develop following the procedure.