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Spine Surgery

Lower Back (Lumbar) Surgery :: Minimally Invasive Spine Surgery for Spondylolisthesis
Minimally Invasive Spine Surgery :: Posterior Spinal Fusion :: Spinal Fusion with Instrumentation

Lower Back (Lumbar) Surgery

Low back pain is one of the most common health problems experienced by a majority of individuals, at different phases of their lives.

The most common causes of low back pain include:

  • Lumbar spinal stenosis
  • Herniated disc
  • Adult degenerative spondylolisthesis
  • Degenerative disc disease

Most patients with low back pain do not require surgery for the management of their condition. However, surgery may be beneficial in patients with persistent pain, spinal instability, weakness or numbness in legs or feet, and impaired bowel or bladder function. Lumbar spine surgery may also be considered if all the conservative methods have failed to provide pain relief.

An open surgery or a minimally invasive technique can be used to relieve nerve compression and stabilize the lumbar spine. Your surgeon may choose a minimally invasive approach rather than open spine surgery, due to the lower incidence of complications with a minimally invasive surgery.

Spinal fusion with instrumentation has been used to treat many painful conditions of the lumbar spine. In spinal fusion surgery two or more vertebrae are joined together with the help of bone grafts to eliminate the movement between them. Spinal instrumentation is used to stabilize the spine, after the fusion, with the help of implants such as rods, plates, screws, and interbody devices.

There are several types of lumbar spine surgeries. If you require a surgery, your doctor will decide on the most appropriate type of surgery, based on your condition. Some of the different lumbar surgeries include:

  • Anterior and posterior lumbar interbody fusion (ALIF or PLIF)
  • Direct lateral lumbar interbody fusion (DLIF)
  • Axial lumbar interbody fusion (AxiaLIF)
  • Intradiscal Electrothermoplasty (IDET)
  • Transforaminal lumbar interbody fusion (TLIF)
  • Image Guided Spine Surgery
  • Laminoplasty
  • Laminotomy

Before surgery

Before the surgery, your doctor will explain the surgical procedure as well as its risks and complications to you. You should obtain a medical clearance, from your physician, before proceeding with the surgery. Your doctor may also order a few blood tests, X-rays, or other imaging tests to assess your medical condition.

After surgery

After the surgery, you will be shifted to the recovery room where your vital signs will be closely monitored by the medical staff. You may have mild discomfort following the surgery.

Post-operative care

You should keep your incision area clean and dry. You should not smoke, drive, lift heavy things, swim or use a hot tub. Start physical therapy as directed by your doctor. Take medications as recommended by your doctor as well as arrange a follow-up appointment with your doctor.

Risks

The possible risks associated with lumbar spine surgery may include infection, bleeding, problems with anesthesia, and nerve or spinal cord injury.

Call you doctor if you experience a fever over 101° F or if the incision site shows signs of infection such as pain, redness, swelling, or alteration in the quantity or smell of the drainage. Also contact your doctor if you experience difficulty with bowel or bladder function or numbness over the genital area.

Minimally Invasive Spine Surgery for Spondylolisthesis

Spondylolisthesis is a condition of the spine characterized by the forward displacement of a vertebra over an underlying vertebra. A significant displacement can cause a compression of the spinal nerves resulting in pain. The two most common types of spondylolisthesis include dysplastic spondylolisthesis and isthmic Spondylolisthesis.

A majority of patients with spondylolisthesis are treated with a non-surgical approach, comprising of medication, spinal injection therapies, and physical therapy. Surgery is an option for patients with progressive displacement of the vertebra, pain not improving with conservative treatment measures, and difficulty in performing daily activities. Your surgeon may choose a minimally invasive approach rather than open approach for the surgery. Both open and minimally invasive techniques relieve the pressure over the spinal nerves and stabilize the spine.

Spondylolisthesis is treated with spinal fusion and instrumentation. Spinal Fusion is a surgical technique in which the intervertebral disc, present in between two vertebrae, is removed and the adjacent vertebrae are joined with the help of bone grafts. Metal implants such as rods, plates or screws are used to hold the spine firmly in place, during the healing process.

The advantages of minimally invasive spine surgery over open surgery for spondylolisthesis includes smaller incisions, less soft tissue damage, minimal blood loss, reduced operative time, minimal post operative pain, shorter hospital stay, faster recovery, quicker return to daily activities, and less scarring.

The different types of spine procedures performed using minimally invasive technique include:

  • Anterior lumbar interbody fusion (ALIF)
  • Posterior lumbar interbody fusion (PLIF)
  • Lateral Lumbar Interbody Fusion (XLIF)
  • Transforaminal lumbar interbody fusion (TLIF)
  • Direct lateral lumbar interbody fusion (DLIF)
  • Axial lumbar interbody fusion (AxiaLIF)
  • Image Guided Spine Surgery

Before surgery

Prior to your surgery, your surgeon will explain the surgical procedure, type of procedure, and its associated risks and benefits to you. You may need to get a medical clearance from your physician for the surgery. Your doctor may also order medical tests, which may include a few blood tests, X-rays or other imaging tests to assess your medical condition.

After surgery

After the surgery, you will be transferred to the recovery room and your condition will be monitored, till it stabilizes. You may experience a slight discomfort, pain at the incision site, muscle spasms in the neck or back, or other related symptoms following the surgery. You may need to wear a lumbar brace to support the spine during the healing process.

Post-operative care

After surgery, do make sure to keep your incision area clean and dry. You should not drive, smoke, lift heavy things, swim, or use hot tubs. Start your physical therapy as guided by your surgeon. Take the medications as instructed by your surgeon and also schedule a follow-up visit with him.

Risks

As with any surgical procedure, there are certain potential risks and complications associated with spondylolisthesis surgery and may include infection at the site of surgery, the risk of adverse reactions to the anaesthetic, injury to the nerves or spinal cord and blood loss.

You should immediately call your doctor 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. In addition, if you have problems with bowel or bladder control or numbness over the genital area, inform your doctor immediately.

Minimally Invasive Spine Surgery

Traditional open spine surgeries are performed through a long incision. Over the recent years, a minimally invasive approach has emerged as an alternative to open spine surgery. The main difference between the minimally invasive spine surgery and the traditional spine surgery is the size of the incision and extent of muscle dissection. A traditional spine surgery requires a long incision with an excision of the muscle while a minimally invasive surgery employs smaller incisions and less muscle dissection.

Minimally invasive procedures are performed with the help of an endoscope and small surgical instruments which are passed through the small incisions, to access the spine and perform the surgery. An endoscope has a tiny video camera attached to its end, which illuminates and provides better visualization of the operating area. Segmental, tubular retractors and dilators are used to dilate and retract the muscles and soft tissues to access the spine. After the procedure, the endoscope and the instruments are removed and the incisions are closed.

Advantages

The advantages of minimally invasive spine surgery over traditional spine surgery include:

  • Smaller incisions
  • Shorter duration of hospital stay
  • Reduced operative time
  • Less damage to the surrounding tissues
  • Quicker recovery
  • Minimal blood loss
  • Less scarring
  • Quicker return to work and activities
  • Minimal post-operative pain

Procedures that may be performed via minimally invasive spine approach include anterior cervical discectomy and fusion (ACDF), Anterior and posterior lumbar interbody fusion (ALIF or PLIF) direct lateral lumbar interbody fusion (DLIF), axial lumbar interbody fusion (AxiaLIF), intradiscal electrothermal annuloplasty (IDET), posterior cervical laminectomy and fusion, kyphoplasty, and transforaminal lumbar interbody fusion (TLIF).
Before the surgery your doctor will explain the specific procedure as well as its benefits and risks to you.

Risks and Complications

As with any major surgery there are certain potential risks and complications associated with minimally invasive spine surgery as well and may include infection, bleeding, problems with anesthesia, and nerve injury.

Posterior Spinal Fusion

Spinal fusion is a surgical procedure in which two or more vertebrae are joined together, eliminating any movement between them. This procedure is performed by placing bone grafts or bone graft substitutes in between the affected vertebrae to promote bone growth and eventually fuse the vertebrae into a single, solid bone. Spinal instrumentation or implants such as rods, plates, screws, and interbody devices are used to stabilize the spine after fusion. In posterior spinal fusion, the spine is approached from the back. The common types of posterior spinal fusion procedures include:

  • Posterior Lumbar Interbody Fusion (PLIF)
  • AxiaLIF
  • Posterior Cervical Laminectomy and Fusion
  • Minimally Invasive Spine Surgery

Direct Lateral Interbody Fusion (DLIF): This is another surgical approach where the spine is approached through a small incision made at the side of the spine. DLIF is a minimally invasive technique; the underlying soft tissues and the muscles are gently separated rather than cut. The spine is accessed through the psoas muscle.

The success of posterior spinal fusion is based on your body’s ability to heal and produce new bone.  Your general health and co-existing conditions such as diabetes, endocrine disease, and osteoporosis can also alter the healing process. Your doctor may recommend specific tests to evaluate your medical condition. If you have a pre-existing medical disorder, you can follow certain measures to reduce your risk for failure of fusion:

  • Quit smoking: Smoking decreases the blood circulation, slows the healing process and thus increases the risk of spinal fusion failure.
  • Eat a  proper nutritional diet to fuel the body during the healing process
  • Exercise, under the guidance of your surgeon, to enhance the healing process
  • Get adequate rest after surgery

Consult your surgeon for any concerns or queries about posterior spinal fusion surgery.

Spinal Fusion with Instrumentation

Spinal Fusion is a surgical technique in which two or more vertebrae are joined with the help of bone grafts and/or instrumentation. During spinal fusion a piece of bone (bone graft), taken from another bone of the body or from a bone bank ,is placed between the adjacent vertebrae. During the healing process, the graft fuses with the vertebrae leading to the formation of a solid mass of bone which stabilizes the spine.

Spinal instrumentation is a method of stabilizing the spine after fusion with the help of implants such as rods, plates, screws, and interbody devices. These spinal devices and implants firmly hold the vertebrae together, during the healing process.

Spinal fusion permanently joins two or more vertebrae and the instrumentation stabilizes the spine after surgery. Common surgical procedures that involve spinal fusion and instrumentation include:

  • Anterior Lumbar Interbody Fusion (ALIF)
  • Posterior Lumbar Interbody Fusion (PLIF)
  • Transforaminal Interbody Fusion (TLIF)
  • Direct Lateral Interbody Fusion (DLIF)
  • Axial Lumbar Interbody Fusion – AxiaLIF
  • Anterior Cervical Discectomy

Spinal fusion and instrumentation may be performed to treat spinal instability caused by some spinal conditions or surgical procedures. Spinal fusion may not always be successful; its success is based on your body’s ability to heal and produce new bone.  Your general health including co-existing conditions such as diabetes, endocrine disease, and osteoporosis may also affect healing. Your doctor may recommend specific tests to evaluate your medical condition. If you have a pre-existing health condition, you can follow certain measures to reduce the risk of fusion failure:

  • Stop cigarette smoking or tobacco use
  • Eat a healthy and nutritious diet to fuel the body during the healing process
  • Exercises must be performed during your recovery, to enhance the healing process
  • Get plenty of rest after surgery

Follow your surgeon’s instructions to increase your chances of a successful outcome. Talk to your surgeon about any concerns on spinal fusion with instrumentation.

Meet our Doctors

David Tomasek, MD

David Tomasek, MD

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Jose Rodriguez, MD

Jose Rodriguez, MD

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Kenneth Lee, MD

Kenneth Lee, MD

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William Donovan, MD

William Donovan, MD

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