Minimally Disruptive Spine Surgery
Disorders that once required open surgery such as spinal fractures, degenerative disc disease, herniated disc, and spinal deformities can now be treated with minimally disruptive procedures. The goal of this type of surgery is to reduce trauma to the body and allow a faster return to normal activities. For patients who once faced the prospect of open back surgery and a lengthy recovery period, minimally disruptive spine surgery may have opened up a new frontier in treatment.
With traditional back surgery, significant tissue damage can occur. Through a 5-6 inch lumbar (back) incision, the surgeon has to dissect and retract the muscles of the lower back in order to access the spine. Depending on the surgery, blood vessels are moved or cauterized and bone is removed before placement of orthopedic hardware is possible. Although this type of manipulation is necessary, it is traumatic to the tissue and hard on the patient. A lengthy hospital stay, significant blood loss and a long, painful recovery period are closely associated with traditional back surgery. In contrast, minimally disruptive spine procedures may result in less blood loss, reduced postoperative pain, and a short recovery period.
Minimally disruptive spine surgery utilizes computer-assisted imaging and specialized instrumentation to perform traditional surgery, but without the trauma. Incision sites are small and the muscle-sparing techniques assist to minimize blood loss and reduce postoperative pain.
The XLIF® Procedure
The XLIF procedure is a minimally disruptive approach to traditional lumbar interbody fusion. Like all minimally disruptive spine surgery techniques, the XLIF procedure was developed from the need to treat disorders of the spine with the least amount of tissue (muscles, ligaments, blood vessels, and abdominal organs) disruption possible, so that there is minimal tissue-related damage from the surgery, and the recovery time is therefore reduced. The XLIF procedure is an innovative technique because it allows the surgeon to access the spine from the side of the body, which inherently means less soft tissue to have to traverse to get to the spine. Some XLIF procedures can be done on an outpatient basis; otherwise, the hospital stay is typically 24 – 48 hours. Perhaps the most impressive aspect of minimally disruptive spine surgery is that, unlike traditional spine surgery, patients report having a positive surgical experience.
Your physician might determine that an XLIF procedure is a good option for you if you require an intervertebral fusion at any lumbar level between L1 and L5, if you do not require direct nerve decompression through the same approach, and you would benefit from a less disruptive approach.
There are a few specific instances where the XLIF procedure cannot be performed. These instances include: some deformities with significant rotation, high-grade spondylolisthesis, and bilateral retroperitoneal scarring (from a prior abscess or abdominal surgery). Additionally, the XLIF procedure cannot be performed on the disc between the 5th lumbar and 1st sacral vertebrae.
Not everyone may be a good candidate for the XLIF procedure. Each patient should be treated individually, and a discussion of suitability should take place between patient and physician, as with any surgery.
The ILIF™ Procedure
The ILIF procedure was developed to overcome the potential shortcomings of standard lumbar spinal stenosis treatments (i.e. decompression alone and decompression with fusion), using a minimally disruptive surgical technique. Lumbar spinal stenosis is a gradual narrowing of the space where nerves pass through the spine, which can be a result of aging and “wear and tear” on the spine from everyday activities and/or resultant positional changes of the vertebrae. The most common surgical treatment for lumbar spinal stenosis is a procedure called a decompression, which involves removing bone or ligaments that are pressing on the spinal cord and/or nerves.
The ILIF procedure involves a minimally disruptive decompression procedure called a laminotomy, which involves temporary distraction (opening up) of the space between the spinous processes, and careful removal of only small sections of bone to relieve the pressure on the spinal cord and nerves. ILIF utilizes a uniquely designed precision-machined allograft (donor) bone that is placed between the spinous processes across the lamina to promote a fusion (growth and connection of two bones) between the lamina and spinous processes to provide long-term spine stabilization. ILIF also utilizes a minimally disruptive stabilization device called a spinous process plate that attaches to both spinous processes to stabilize the segment of the spine and promote fusion, eliminating the need for more extensive surgery. Biomechanical testing indicates the plate is comparable to traditional pedicle screw fixation.
Most ILIF patients are discharged from the hospital the next day, but your physician will determine the best post-operative course for you, depending on your comfort and any other health problems you may have. In general, ILIF surgery results in quick recovery and return to normal activities.
Only your physician can determine if ILIF is right for you.
MAS® TLIF
In a traditional TLIF (Transforaminal Lumbar Interbody Fusion) procedure, the muscle is dissected from the middle out to the side, but only to one side of the back, sparing trauma to the opposite side. NuVasive’s MAS platform provides surgical tools that allow for a less disruptive TLIF approach without compromising the surgical access and ultimate surgical goals. The advantages of MAS TLIF are the same as the traditional TLIF, but with the added benefit of less muscle disruption and therefore less postoperative pain and quicker recovery.
Because this procedure is less disruptive than conventional posterior surgery, most patients are able to get up and walk around the evening after surgery. Most MAS TLIF patients are discharged from the hospital the next day, but your physician and healthcare team will determine the best postoperative course for you, depending on your comfort and any other health problems you might have.
Your physician might determine a MAS TLIF procedure is a good option for you if you require an intervertebral fusion at any lumbar level between L1 and S1, and you would benefit from a less disruptive approach. Conversely, your physician might determine that a MAS TLIF procedure is not a good option for you if you are not a good candidate for fusion surgery in general due to other medical conditions.
Leverage™ LFS
Many different techniques have been applied to treat cervical stenosis; yet, it remains a demanding problem to address. Most of the techniques all share similar drawbacks, requiring care to prevent fracturing the hinge during preparation of the lamina and creating concerns due to the necessity of working over an exposed cord. NuVasive identified a need for a system that could be implanted with minimal risk. This need was answered by the development of the NuVasive Leverage Laminoplasty Fixation System (LFS).
The goal of Leverage LFS is to introduce a complete laminoplasty system that can provide the surgeon with an easy, safe, and reproducible open door laminoplasty procedure. It is designed to provide a greater level of patient safety and ease-of-use while retaining all the benefits of the open door laminoplasty procedure.
Leverage LFS is intended for use in the lower cervical and upper thoracic spine (C3 to T3) in laminoplasty procedures. It is used to hold allograft material in place in order to prevent the allograft material from expulsion, or impinging the spinal cord.
As with any major surgical procedure, there are risks involved in orthopedic surgery. Infrequent operative and postoperative complications known to occur are: early or late infection, which may result in the need for additional surgeries, damage to blood vessels, permanent pain and/or deformity. Only your physician can determine if Leverage LFS is right for you.
XL TDR® (eXtreme Lateral Total Disc Replacement)
Unlike other total disc replacement devices, XL TDR is a total disc replacement that is implanted from the patient’s side, an approach which radically improves the patient experience. In conjunction with SOLAS®, the Society of Lateral Access Surgery, NuVasive® is pleased to be sponsoring a clinical study designed to demonstrate the safety and efficacy of XL TDR.
XL TDR seeks to relieve the painful symptoms associated with lumbar degenerative disc disease. However, instead of achieving pain relief through fusion (immobilization of the spinal segment), XL TDR seeks to relieve pain while restoring height and maintaining motion at the spinal segment. Through thoughtful and careful scientific study, we seek to demonstrate the safety and efficacy of this device, compared to other fusion procedures.
To learn more about the XL TDR clinical study, please visit www.XLMotion.com
For more information about minimally disruptive surgical techniques, visit www.nuvasive.com.
It is important that you discuss the potential risks, complications, and benefits of minimally disruptive spine surgery with your doctor prior to receiving treatment and that you rely on your physician’s judgment. Only your doctor can determine whether you are a suitable candidate for this treatment. To find a surgeon in your area who performs the XLIF procedure, please use the Physician Locator featured on this Web site. To find a surgeon who performs the ILIF procedure, MAS TLIF, or Leverage LFS, please contact us at info@thebetterwayback.org.