Treatment options

What is an ACDF?

An anterior cervical discectomy and fusion (ACDF) procedure is a type of cervical spine surgery where the surgeon approaches the spine from the front (anterior) of the neck (cervical spine). The surgeon removes the damaged spinal disc and inserts a bone graft (implant) in its place. The goal of the procedure is to then stimulate the above and below vertebrae to grow together into one solid bone in a process known as fusion. Fusion creates a rigid and immovable column of bone in the problem section of the spine. This type of procedure attempts to reduce pain and other symptoms.

Anterior approaches like ACDF allow access to the discs at the front of the spine and do not require muscle stripping as with posterior approaches.

Can an ACDF be right for me?

Your physician might determine an ACDF procedure is a good option for you if you require an interbody fusion, are skeletally mature and have received at least six weeks of nonsurgical treatment.

Conversely, your physician may determine that an ACDF 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. These conditions can be, but are not limited to: signs of inflammation or infection near the operative site, patient sensitivity to implant materials, patients with inadequate bone quality and other indications.

What are the potential risks of an ACDF procedure?

Keep in mind that all surgery presents risks and complications that are important to discuss with your surgeon prior to your surgery. Listening to your physician’s guidance, both before and after surgery, will assist with your recovery.

Potential risks following an ACDF procedure include: cervical edema (swelling); dysphagia (difficulty swallowing); dysphonia (hoarseness); vocal cord paralysis; laryngeal palsy; sore throat; recurring aspirations; nerve deficits or damage; tracheal, esophageal and pharyngeal perforation; airway obstruction; deficit or damage to the spinal cord, nerve roots or nerves possibly resulting in paralysis and dural tears leaking; cerebrospinal fistula; discitis, arachnoiditis and other types of inflammation; loss of disc height; loss of proper curvature, correction, height or reduction of the spine; vertebral slipping; scarring, herniation and degeneration of adjacent discs; surrounding soft tissue damage, spinal stenosis, myelopathic and radicular symptoms; spondylosis; otitis media; fistula; vascular damage and rupture; and headache.

This is not intended to be a complete list of the possible complications. Please contact your physician to discuss all potential risks.

What is an ALIF?

In an anterior lumbar interbody fusion (ALIF) procedure, the surgeon works on the spine from the front (anterior) and removes a spinal disc in the lower (lumbar) spine. The surgeon inserts a bone graft into the space between the two vertebrae where the disc was removed (the interbody space). The goal of the procedure is to stimulate the vertebrae to grow together into one solid bone, a process known as fusion. Fusion creates a rigid and immovable column of bone in the problem section of the spine. This type of procedure attempts to reduce back pain and other symptoms.

Anterior approaches, such as in ALIF, allow access to the discs from the front of the spine and do not require muscle stripping as in posterior approaches.

Can an ALIF be right for me?

Your physician might determine an ALIF procedure is a good option for you if you require an interbody fusion, are skeletally mature and have received at least six weeks of nonsurgical treatment.

Conversely, your physician may determine that an ALIF 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. These conditions can be, but are not limited to: signs of inflammation or infection near the operative site, patient sensitivity to implant materials, patients with inadequate bone quality, previous retroperitoneal surgery, previous aortic bypass or endovascular stent graft, and other indications.

What are the potential risks of an ALIF procedure?

Keep in mind that all surgery presents risks and complications that are important to discuss with your surgeon prior to your surgery. Listening to your physician’s guidance, both before and after surgery, will assist with your recovery.

Potential risks following an ALIF procedure include: problems with anesthesia; blood vessel damage; nerve or spinal cord damage; problems with the interbody device or hardware; retrograde ejaculation (in males); and ongoing pain.

This is not intended to be a complete list of the possible complications. Please contact your physician to discuss all potential risks.

What is a laminectomy?

Laminectomy is a spinal surgical procedure that attempts to relieve pressure on the spinal cord, cauda equina or nerve roots in the spine. It is most commonly performed to relieve the pain resulting from spinal stenosis. Surgeons may treat one or more levels of the spine depending on where the spinal stenosis is located.

Can a laminectomy be right for me?

Your physician might determine a laminectomy procedure is a good option for you if non-surgical treatment has failed to improve your condition, you feel numbness or weakness in your legs that makes walking or standing difficult, and/or you experience loss of bowel or bladder control.

Conversely, your physician may determine that a laminectomy is not a good option for you due to other medical conditions.

What are the potential risks of a laminectomy procedure?

Keep in mind that all surgery presents risks and complications and it is important to discuss them with your physician prior to your surgery. Listening to your physician’s guidance both before and after surgery assist with your recovery.

Risks associated with the laminectomy procedure include: bleeding, infection, blood clots, nerve injury, and spinal fluid leak.

This is not intended to be a complete list of the possible complications. Please contact your physician to discuss all potential risks.

What is a lumbar discectomy?

Lumbar discectomy is a spinal surgical procedure that attempts to relieve pressure on the nerve roots in the lumbar spine. It is most commonly performed to relieve the pain resulting from a ruptured or herniated disc.

Can a lumbar discectomy be right for me?

Your physician might determine a lumbar discectomy procedure is a good option for you if nonsurgical treatment has failed to improve your condition, you feel numbness or weakness in your legs that makes walking or standing difficult, and/or you experience loss of bowel or bladder control.

What are the potential risks of a lumbar discectomy procedure?

Keep in mind that all surgery presents risks and complications are important to discuss with your physician prior to your surgery. Listening to your physician’s guidance both before and after surgery will assist with your recovery.

Risks associated with the discectomy procedure include but may not be limited to: bleeding, infection, blood clots, nerve injury, and spinal fluid leak.

This is not intended to be a complete list of the possible complications. Please contact your physician to discuss all potential risks.

What is MAS Midline?

Lumbar interbody fusion is a surgical technique that attempts to eliminate instability in the back. A Maximum Access Surgery posterior lumbar interbody fusion (MAS Midline) seeks to achieve this by using a less invasive approach to fuse one or more vertebrae together to reduce their motion.

The distinct difference between a traditional “open” posterior lumbar interbody fusion (PLIF) and a MAS Midline is the medialized surgical approach. The MAS Midline procedure is designed to eliminate the need to retract muscle laterally, therefore requiring a smaller incision than an “open” PLIF. By minimizing the amount of muscle disruption, this procedure is intended to reduce postoperative approach-related muscle pain and enable a faster recovery for the patient.

Can a MAS Midline be right for me?

Your physician might determine a MAS Midline 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 than traditional open techniques.

Conversely, your physician may determine that a MAS Midline procedure is not a good option for you. It is important to discuss this with your physician in order to determine the best course of treatment for you.

What are the potential benefits of a MAS Midline procedure?

When compared to traditional open techniques, MAS Midline has:

• reduced blood loss,¹
• shorter hospital stay,¹
• smaller incision, and
• less muscle disruption.

What are the potential risks of a MAS Midline procedure?

Keep in mind that all surgery presents risks and complications that are important to discuss with your surgeon prior to your surgery. Listening to your physician’s guidance, both before and after surgery, will help your recovery.

Potential complications following MAS Midline surgery include, but may not be limited to: problems with anesthesia, infection, nerve damage, problems with the graft or hardware and ongoing pain.

This is not intended to be a complete list of the possible complications. Please contact your physician to discuss all potential risks.

References

1. Goldstein CL, Phillips FM, Rampersand YR. Comparative effectiveness and economic evaluations of open versus minimally invasive posterior or transforaminal lumbar fusion: a systematic review. Spine 2016;41:74-89.

What is a MAS TLIF?

Lumbar interbody fusion is a surgical technique that attempts to eliminate instability in the back. A Maximum Access Surgery Transforaminal Lumbar Interbody Fusion (MAS TLIF) achieves this by using a less invasive approach to fuse one or more vertebrae together to reduce their motion.

Rather than starting from the middle of the back and spreading the muscles to the sides as is done in traditional back surgery, the MAS TLIF approach starts off to one side of the spine and splits (rather than cuts) the back muscles in one direction. This allows the surgeon to make a smaller incision with less muscle injury, which may result in less postoperative pain and a quicker recovery.

Can a MAS TLIF be right for me?

Your physician might determine a MAS TLIF procedure is a good option for you if you require a spinal fusion at any lumbar level between L1 and S1, and you would benefit from a less disruptive approach than traditional open techniques.

Conversely, your physician may determine that a MAS TLIF procedure is not a good option for you. It is important to discuss this with your physician in order to determine the best course of treatment for you.

What are the potential benefits of a MAS TLIF procedure?

When compared to traditional open techniques, MAS TLIF has:

• reduced blood loss^1–3
• shorter hospital stay^1–3
• smaller incision

What are the potential risks of a MAS TLIF procedure?

Keep in mind that all surgery presents risks and complications that are important to discuss with your surgeon prior to your surgery. Listening to your physician’s guidance, both before and after surgery, will assist with your recovery.

Potential complications following MAS TLIF surgery include, but may not be limited to: problems with anesthesia, infection, nerve damage, problems with the graft or hardware, and ongoing pain.

This is not intended to be a complete list of the possible complications. Please contact your physician to discuss all potential risks.

References

1. Goldstein CL, Phillips FM, Rampersaud YR. Comparative effectiveness and economic evaluations of open versus minimally invasive posterior or transforaminal lumbar interbody fusion. Spine 2016;41(8S)S74-89.
2. Sembrano, JN, Tohmeh A, Isaacs R, et al. Two-year Comparative Outcomes of MIS Lateral and MIS Transforaminal Interbody Fusion in the Treatment of Degenerative Spondylolisthesis. Spine 2016;41(8S):123-32.
3. Isaacs RE, Sembrano JN, Tomeh AG, et al. Two-Year Comparative Outcomes of MIS Lateral and MIS Transforaminal Interbody Fusion in the Treatment of Degenerative Spondylolisthesis. Spine 2016; 41(8S):133-44.

What is a PCF?

A posterior cervical fusion (PCF) is the technique of joining the bones of the cervical spine together. Following the procedure, the bones heal into one solid bone through a process called fusion. This creates an internal brace to stabilize the cervical spine. This type of procedure attempts to reduce painful motion and/or spinal cord/nerve compression.

Can a PCF be right for me?

Your physician may determine that the PCF procedure is a good option for you if you require an interbody fusion, are skeletally mature, and have received at least six weeks of nonsurgical treatment.

Conversely, your physician may determine that a PCF 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. These conditions can be, but are not limited to: sensitivity to general anesthesia, inability to tolerate a prone position, inadequate bone quality, as well as other indications.

What are the potential risks of a PCF procedure?

Keep in mind that all surgery presents risks and complications that are important to discuss with your surgeon prior to your surgery. Listening to your physician’s guidance, both before and after surgery, will assist with your recovery.

Potential risks following a PCF procedure include: axial neck pain, morbidity (incidence of disease), stiffness, loss of range of motion, paralysis, bleeding requiring a blood transfusion, failure of the fusion, failure of the instrumentation, nerve root injury, and dural tears.

This is not intended to be a complete list of the possible complications. Please contact your physician to discuss all potential risks.

What is a posterior fixation?

Posterior fixation for the thoracolumbar spine is a procedure intended to provide realignment, immobilization, and stabilization of spinal segments in skeletally mature patients throughout the healing process, allowing fusion to occur.

Can a posterior fixation be right for me?

Your physician might determine posterior fixation is a good option for you if you require additional support for your interbody fusion procedure, are skeletally mature, and have gone through six weeks of non-surgical treatment. Interbody fusion is a surgical technique that attempts to restabilize the back.

Conversely, your physician may determine that posterior fixation is not a good option for you if you are not a good candidate for fusion surgery in general due to other medical conditions. These conditions can be but are not limited to, signs of inflammation or infection near the operative site, patient sensitivity to implant materials, patients with inadequate bone quality, and other indications.

What are the potential risks of a posterior fixation procedure?

Keep in mind that all surgery presents risks and complications that are important to discuss with your surgeon prior to your surgery. Listening to your physician’s guidance, both before and after surgery, will help your recovery.

potential risks following a posterior fixation procedure include: problems with anesthesia, infection, nerve damage, problems with the implants or hardware, and ongoing pain.

This is not intended to be a complete list of the possible complications. Please contact your physician to discuss all potential risks.

What is an XLIF?

The eXtreme Lateral Interbody Fusion (XLIF) technique is a minimally disruptive surgical procedure performed through the side of the body. It is designed to treat a range of spinal pathologies. Using nerve monitoring technology, the surgeon gains lateral (side) access to the spinal column, avoiding any major nerves in the area between the incision and the column. The XLIF procedure does not require an anterior (front) or posterior (back) exposure, and thereby does not present the same risks of vascular and/or neural injury as traditional approaches.

Can an XLIF be right for me?

If you require spinal surgery, your physician may determine that the XLIF procedure is a good option for you. Some examples of pathologies (conditions) that may benefit from the XLIF procedure include:

• degenerated discs and/or facet joints that cause unnatural motion and pain;
• slippage of one vertebra over another (degenerative spondylolisthesis); and
• change in the normal curvature of the spine (degenerative scoliosis).

Conversely, your physician may determine that an XLIF procedure is not a good option for you. It is important to discuss this with your physician in order to determine the best course of treatment for you.

What are the potential benefits of an XLIF procedure?

Benefits of an XLIF procedure, when compared to traditional lumbar interbody fusion surgery, may include:

• smaller incision;
• less blood loss during surgery; ^1–4
• reduced operative time;
• reduced hospital stay;^1–5 and
• reduced postoperative recovery time.^6,7

What are the potential risks of an XLIF procedure?

Keep in mind that all surgery presents risks and complications that are important to discuss with your surgeon prior to your surgery. Listening to your physician’s guidance, both before and after surgery, will assist with your recovery.

Potential risks following XLIF surgery include: problems with anesthesia, infection, nerve damage, problems with the graft or hardware, and ongoing pain.

This is not intended to be a complete list of the possible complications. Please contact your physician to discuss all potential risks.

References

1. Oliveira L, Marchi L, Coutinho E, et al. The use of rh-BMP2 in standalone eXtreme Lateral Interbody Fusion (XLIF^®): clinical and radiological results after 24 months follow-up. WscJ 2010;1(1):19-25.
2. Dakwar E, Cardona RF, Smith DA, et al. Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus 2010;28(3):E8.
3. Dhall SS, Wang MY, Mummaneni PV. Clinical and radiographic comparison of mini–open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up. J Neurosurg Spine 2008;9:560-5.
4. Whitecloud TS 3rd, Roesch WW, Ricciardi JE. Transforaminal interbody fusion versus anteriorposterior interbody fusion of the lumbar spine: a financial analysis. J Spinal Disord 2001;14(2):100–3.
5. Lucio JC, VanConia RB, DeLuzio KJ, et al. Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period. Risk Manag Healthc Policy 2012;5(5):65-74.
6. Ozgur BM, Agarwal V, Nail E, et al. Two-year clinical and radiographic success of minimally invasive lateral transpsoas approach for the treatment of degenerative lumbar conditions. SAS J 2010;4:41–6.
7. Park Y, Ha JW. Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine 2007;32(5):537-43.

What is an XLIF Corpectomy?

The XLIF Corpectomy technique is a minimally disruptive surgical procedure performed through the side of the body. A corpectomy (with corpus meaning “body”, and ectomy meaning “remove”) is a procedure where the vertebral body and the adjoining discs are removed. An XLIF Corpectomy is used to treat patients suffering from severe spinal cord injuries resulting from trauma or tumors where a large part of the vertebrae must be removed.

Nerve monitoring technology is used to gain lateral (side) access to the spinal column, avoiding any major nerves in the area between the incision and the column. Traditional surgical options for addressing a corpectomy typically involve large exposures. The XLIF Corpectomy procedure allows surgeons to treat corpectomy patients through a smaller incision while still providing surgeons direct visualization to the affected area.

Can an XLIF Corpectomy be right for me?

If you require spinal surgery, your physician may determine that the XLIF Corpectomy procedure is a good option for you.

Some examples of pathologies that may be ideal for the XLIF Corpectomy procedure include vertebral body fracture(s) and vertebral body tumor.

Conversely, your physician may determine that an XLIF Corpectomy procedure is not a good option for you. It is important to discuss this with your physician.

What are the potential risks of an XLIF Corpectomy procedure?

Keep in mind that all surgery presents risks and complications that are important to discuss with your surgeon prior to your surgery. Listening to your physician’s guidance, both before and after surgery, will assist with your recovery.

Potential risks following XLIF corpectomy surgery include: problems with anesthesia, infection, nerve damage, problems with the graft or hardware, and ongoing pain.

This is not intended to be a complete list of the possible complications. Please contact your physician to discuss all potential risks.