Anterior lumbar interbody fusion (ALIF) is a spine surgery that involves approaching the spine from the front of the body to remove disc or bone material from in between two adjacent lumbar vertebrae. The procedure may be performed either as an open surgery or using minimally invasive techniques.

What Is An ALIF?

Anterior lumbar interbody fusion (ALIF) is a spine surgery that involves approaching the spine from the front (anterior) of the body to remove all or part of a herniated disc from in between two adjacent vertebrae (interbody) in the lower back (lumbar spine), then fusing, or joining together, the vertebrae on either side of the remaining disc space using bone graft or bone graft substitute.

The graft material acts as a binding medium and also helps maintain normal disc height – as the body heals, the vertebral bone and bone graft eventually grow together and stabilize the spine. Instrumentation, such as rods, screws, plates, cages, hooks and wire also may be used to create an “internal cast” to support the vertebral structure during the healing process.

Depending on your condition and your surgeon’s training, experience and preferred methodology, an ALIF may be done alone or in conjunction with another spinal fusion approach. Please discuss your fusion approach options thoroughly with your doctor, and rely on his or her judgment about which is most appropriate for your particular condition.

Why Do I Need This Procedure?

There are a number of reasons your surgeon may recommend spinal fusion. This procedure is frequently used to treat:

• One or more fractured (broken) vertebrae
• Spondylolisthesis (slippage of one vertebral bone over another)
• Abnormal curvatures of the spine, such as scoliosis or kyphosis
• Protruding or degenerated discs (the cartilaginous “cushions” between vertebrae)
• Instability of the spine (abnormal or excessive motion between two or more vertebrae)

Patients with low back and/or leg pain due to degenerative disc disease, spondylolysis/spondylolisthesis, scoliosis, or other spinal instability that have not responded to non-surgical treatment measures (rest, physical therapy or medications) may be suitable candidates for an ALIF.

Patients without an excessive amount of spinal instability or slippage, and who have little to no spinal stenosis or nerve compression in the back of the spine, are generally the best candidates for an ALIF alone. However, ALIF as a stand-alone technique is usually not recommended for people whose bones have become very soft due to osteoporosis, or in patients with instability or arthritis.

Your surgeon will take a number of factors into consideration before recommending an ALIF, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. Please discuss this treatment option thoroughly with your spinal care provider.

How Is An ALIF Performed?

For an ALIF procedure, the patient is positioned on his or her back and sedated under general anesthesia. The surgeon then:

• Makes an incision in the abdomen and retracts the abdominal muscles, organs and vascular structures – including such major blood vessels as the aorta and vena cava – for a clear view of the front of the spine and access to the vertebrae. (This part of the procedure may be performed by a general surgeon or vascular specialist.)
• Removes all or part of the degenerated disc(s) from the affected disc space, and inserts bone graft or bone graft substitute into the disc space between the vertebral bodies, to support the disc space and promote bone healing.
• Returns the abdominal organs, blood vessels and muscles to their normal place, and closes the incision.

Surgeons typically perform an ALIF as a traditional, open procedure as described above; however, another option is to access the spine using minimally invasive (endoscopic) technologies that allow surgeons to reach the affected vertebrae through small incisions and intramuscular tunnels created to accommodate special guidance, illumination and surgical tools.

How Long Will It Take Me To Recover?

The recovery period for a spinal fusion procedure such as an ALIF will vary, depending on the procedure and your body’s ability to heal and firmly fuse the vertebrae together. One advantage of an ALIF is that the back muscles and nerves are undisturbed.

Patients typically stay in the hospital for several days, longer if necessary for more extensive surgery. This may also include time in a rehabilitation unit. Your surgeon will prescribe pain medication as needed, and may recommend a brace and follow-up physical therapy.

The length of time you will be off work will depend on a number of factors: your particular procedure and the physician’s approach to your spine, the size of your incision, and whether or not you experienced any significant tissue damage or complications. Another consideration is the type of work you plan to return to. Typically, you can expect to be on medical leave for 3 to 6 weeks; however, many innovations and advancements have been developed in the last few years that allow for improved fusion rates, shorter hospital stays and a more active and rapid recovery period.

Work closely with your spinal surgeon to determine the appropriate recovery protocol for you, and follow his or her instructions to optimize the healing process.

Are There Any Potential Risks Or Complications?

All treatment and outcome results are specific to the individual patient. Results may vary. Complications such as infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anesthesia, are some of the potential risks of spinal surgery. A potential risk inherent to spinal fusion is failure of the vertebral bone and graft to properly fuse, a condition that may require additional surgery.

Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to the ALIF procedure.

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your health care professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your health care professional for diagnosis and treatment.

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If you have been diagnosed with a spinal fracture/vertebral compression fracture (VCF) caused by osteoporosis, cancer or benign tumors, balloon kyphoplasty may be a treatment option.

What Is Balloon Kyphoplasty?

Balloon kyphoplasty is a minimally invasive, orthopedic procedure for stabilizing spinal fractures that may reduce back pain, correct angular vertebral deformity and restore vertebral body height.

Why Do I Need A Balloon Kyphoplasty?

The National Osteoporosis Foundation cites osteoporosis as a major public health threat affecting 44 million Americans, or 55 percent of people 50 years of age and older. Osteoporosis causes 1.5 million fractures annually, with more than 700,000 of these fractures occurring in the spine.

Spinal fractures can also be caused by cancer, the most common being multiple myeloma, breast, lung and prostate. According to the Multiple Myeloma Research Foundation, 55-70% of Multiple Myeloma patients already have VCFs at the time of diagnosis and 15-30% develop new VCFs annually. ¹

The change in the shape of the vertebral body following fracture alters the body’s center of gravity. Multiple spinal fractures can affect the alignment of the entire spine. Over time, this alteration in spinal configuration may lead to reduction of motion and strength and well as visible spinal deformity known as kyphosis or “dowager’s hump.” ²

How Is Balloon Kyphoplasty Performed?

Balloon kyphoplasty typically takes about one hour per fracture treated. It can be performed on an inpatient or outpatient basis and under local or general anesthesia (both determinations are based on medical necessity). Your physician will discuss with you which options are appropriate for you.

Step 1: Balloon Placement An incision is made approximately 1 cm in length. Using a needle and cannula (tube), the spine specialist creates a small pathway into the fractured bone. A small, orthopedic balloon is guided through the tube into the vertebra. The procedure is done on both sides of the vertebral body.

Step 2: Balloon Inflation Next, balloons are carefully inflated in an attempt to raise the collapsed vertebrae and return it to its pre-fracture position.

Step 3: Cavity Creation In an attempt to create a void (cavity), the balloons are inflated in the vertebral body. Once the vertebral body is in the correct position, the balloon is deflated and removed.

Step 4: Cavity Fill The cavity is filled with bone cement.

Step 5: Internal Cast The bone cement forms an “internal cast” to support the surrounding bone and prevent further collapse.

How Long Will It Take Me To Recover?

The balloon kyphoplasty procedure typically takes about one hour per fracture and may require an overnight hospital stay. Your physician will discuss with you which options are appropriate for you based on your overall condition.

After the procedure, you will likely be transferred to the recovery room for about an hour for observation. While in the hospital, you may be encouraged to walk and move about.

Your surgeon will have a specific post-operative recovery/exercise plan to help you return to your normal daily life as soon as possible. Patients usually report relief from pain and are able to walk and move about soon after the procedure. Your doctor will schedule a follow-up visit and explain limitations, if any, on your activity. Following a balloon kyphoplasty, you may notice a rapid improvement of some or all of your symptoms, including pain; other symptoms may improve more gradually.

Work closely with your physician to determine the appropriate recovery protocol for you, and follow his or her instructions closely to optimize the healing process.

To determine whether you are a candidate for a balloon kyphoplasty, please talk to your doctor.

Are There Any Potential Risks Or Complications?

Although the complication rate for KYPHON� Balloon Kyphoplasty is low, as with most surgical procedures, serious adverse events, some of which can be fatal, can occur, including heart attack, cardiac arrest (heart stops beating), stroke, and embolism (blood, fat or cement that migrates to the lungs or heart). Other risks include infection; leakage of bone cement into the muscle and tissue surrounding the spinal cord and nerve injury that can, in rare instances, cause paralysis; leakage of bone cement into the blood vessels resulting in damage to the blood vessels, lungs and/or heart. This procedure is not for everyone. A prescription is required. Please consult your physician for a discussion of these and other risks and whether this procedure is right for you.

For complete information regarding indications for use, contraindications, warnings, precautions, adverse events, and methods of use, please reference the devices’ Instructions for Use.

Important Safety Information

For more information about balloon kyphoplasty, please visit www.kyphon.com or contact:

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1. Masala et al. Percutaneous Kyphoplasty: Indications and Technique in the Treatment of Vertebral Fractures from Myeloma
McCloskey et al. The Clinical and Cost Considerations of Bisphosphonates in Preventing Bone Complications in Patients with Metastatic Breast Cancer or Multiple Myeloma. Drugs 2001:61 (9):1253-1274.

2. Lyles et al., Association of Osteoporotic Vertebral Compression Fractures with Impaired Functional Status, Am J. Med, 1993.

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Because it involves accessing the spine through a muscle in the side, the direct lateral interbody fusion (DLIF) offers surgeons and their patients a less-invasive option for spine surgery.

What Is A DLIF?

Unless you’ve studied anatomy, chances are you’ve never heard of the psoas (soh-uhs) muscle. One of the “unsung heroes” of the body, this important muscle extends along the length of the lower spine and is responsible for stability, flexion and range of motion in the lower back and hips.

Precisely because of its size and location, it’s also an integral part of a minimally invasive spinal fusion procedure, called direct lateral interbody fusion, or DLIF, that’s been gaining favor in the spine community in recent years.

The direct lateral approach to spinal fusion allows access to the area of the spine to be treated while potentially minimizing disruption of the surrounding soft tissues, nerves and blood vessels.

Gaining clear access to the spine, for both visualization and treatment of the affected vertebrae, is one of the most critical aspects of spinal fusion surgery, and there are several different approaches a surgeon typically takes for an interbody-type procedure. They include approaching the spine from the front of the body through an incision in the patient’s abdomen (anterior lumbar interbody fusion [ALIF]); approaching the spine through an incision in the patient’s back over the vertebrae to be treated (posterior lumbar interbody fusion [PLIF]) or approaching the spine from the side through an incision in the patient’s back (transforaminal lumbar interbody fusion [TLIF]). Factors that influence a surgeon’s decision on which approach to take include the spinal condition to be treated, its location in the spinal column, his or her own training and surgical experience, available technology and the patient’s overall general health.

The DLIF is different from other interbody fusion techniques in that to approach the spine, the surgeon makes a very small incision in the skin of the patient’s side. Then, using minimally invasive surgical techniques, he or she creates a narrow passageway through the underlying soft tissues and the psoas muscle, from the outside of the muscle to the inside � gently separating and weaving through the fibers of the psoas muscle rather than cutting through it � directly to the vertebra(e) and disc to be treated. This is called the transpsoas, or direct-lateral, approach to interbody spinal fusion, because it involves entering the body for access to the spine through the psoas muscle and soft tissues of the side rather than through the abdominal cavity or through a longer incision in the back.

Why Do I Need This Procedure?

Consisting of the five vertebrae (L1-L5) of the lower back, the lumbar spine bears the greatest amount of the body’s weight, making it a common source of back pain. Degenerative conditions, deformity and injury can lead to spinal instability which, if it results in pressure on the spinal cord and/or surrounding nerves, may ultimately cause back pain and/or numbness and muscle weakness that extends into the hips, buttocks and legs.

If these symptoms persist for an extended period of time and have failed to respond to conservative treatment measures such as rest, medication, exercise and physical therapy, your surgeon may recommend a surgical procedure called spinal fusion.

The goal of spinal fusion is to restore spinal stability, and the procedure typically involves removing damaged disc or bone material from in between two adjacent vertebrae (decompression) and then placing bone graft material into the disc space to promote bone growth that permanently joins together the two vertebrae (fusion). Instrumentation such as rods, plates and screws also may be attached to the vertebrae to create an “internal cast” that supports the vertebral structure during the healing process.

How Is A DLIF Performed?

For a minimally invasive DLIF procedure, the patient is positioned on their side on the operating table � this is called the lateral decubitus position � and sedated under general anesthesia. The surgeon then:

• Using a fluoroscope, a type of moving x-ray machine used in the operating room, ensures proper positioning of the vertebra(e) to be treated.
• Makes a very small incision in the skin in the patient’s side, over the midsection of the disc for a single-level fusion or over the intervening vertebral body for a multilevel fusion.
• Using fluoroscopic guidance, inserts a series of dilators through the soft tissues and fibers of the psoas muscle to create a tiny “tunnel” through which the surgeon may view the spine and perform surgery. (A neuromonitoring device also may be used to identify the location of and protect spinal nerve roots.) Through this narrow opening, your surgeon:
  • Removes all or part of the affected disc and surrounding tissues (discectomy).
  • Prepares the bone surfaces of the adjacent vertebrae for fusion.
  • Inserts bone graft into the disc space to promote fusion.
  • Attaches instrumentation, if needed, to the vertebrae for support during the healing process.
• Removes the dilating tubes and closes the incision.

How Long Will It Take Me To Recover?

Your surgeon will have a specific postoperative recovery/exercise plan to help you return to your normal activity level as soon as possible. Following a DLIF procedure, you may notice an immediate improvement of some or all of your symptoms; other symptoms may improve more gradually.

The amount of time that you have to stay in the hospital will depend on your treatment plan. You typically will be up and walking in the hospital by the end of the first day after the surgery. Your return to work will depend on how well your body is healing and the type of work/activity level you plan to return to.

Work closely with your spinal surgeon to determine the appropriate recovery protocol for you, and follow his or her instructions “to the letter” to optimize the healing process.

Are There Any Potential Risks Or Complications?

All treatment and outcome results are specific to the individual patient. Results may vary. Even though the DLIF is minimally invasive, it’s important to remember that it is still spine surgery, and therefore not without risk. Complications such as infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anesthesia, are some of the potential risks of spinal surgery. A potential risk inherent to spinal fusion is failure of the vertebral bone and graft to properly fuse, a condition that may require additional surgery.

It is important that you discuss the potential risks, complications and benefits of direct-lateral interbody fusion with your doctor prior to receiving treatment, and that you rely on your doctor’s judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your health care professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your health care professional for diagnosis and treatment.

Unless Noted Otherwise, All Articles and Graphics Copyright ©2013, Medtronic Sofamor Danek, All Rights Reserved.
Please review our Privacy Policy, Editorial Policy, or Terms Of Use for more information.

A lumbar laminectomy is a spine surgery that involves removing bone to relieve excess pressure on the spinal nerve(s) in the lumbar spine, or lower back. A lumbar laminectomy can be performed to relieve symptoms such as back pain and radiating leg pain.

What Is A Lumbar Laminectomy?

A lumbar laminectomy is a spine surgery that involves removing bone to relieve excess pressure on the spinal nerve(s) in the lumbar spine, or lower back. The term laminectomy is derived from the Latin words lamina (thin plate, sheet or layer), and -ectomy (removal). A laminectomy removes or “trims” the lamina (roof) of the vertebrae to create space for the nerves leaving the spine.

Why Do I Need This Procedure?

Spinal stenosis is a condition caused by a gradual narrowing of the spinal canal. This narrowing happens as a result of the degeneration of both the facet joints and the intervertebral discs. The facet joints also enlarge as they become arthritic, which contributes to a decrease in the space available for the nerve roots. Bone spurs, called osteophytes also can form and grow into the spinal canal.

These processes narrow the spinal canal and may begin to impinge upon and place pressure on the nerve roots and spinal cord, resulting in such symptoms as:

• Back pain
• Pain that radiates into the hips, buttocks and legs
• Numbness, tingling and muscle weakness in the back and/or lower extremities

The goal of a lumbar laminectomy is to relieve pressure on the spinal nerves by removing the part of the lamina that is the source of the pressure.

To determine whether your condition requires treatment with a lumbar laminectomy, your doctor will examine your back and your medical history, and may order an X-ray, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of your spine. A surgical procedure such as a lumbar laminectomy is typically recommended after non-surgical treatment options, such as medication, rest and physical therapy, fail to relieve symptoms after a reasonable length of time.

How Is A Lumbar Laminectomy Performed?

The operation is performed with the patient on his or her stomach, sedated under general anesthesia.

Through an incision made along the midline of the back over the vertebral level(s) to be treated, your surgeon will:

• Gently pull aside soft tissue – skin, fat and muscle – to expose the vertebral bone at the back (posterior) of the spine
• Cut away all or part of the lamina to relieve the source of compression
• Remove any other sources of compression; i.e., bone spurs and/or disc material (discectomy).
• Ease the soft tissues back into place and close the incision.

A lumbar laminectomy also may be performed in conjunction with spinal fusion. This involves placing bone graft or bone graft substitute between two or more affected vertebrae to promote bone growth between the vertebral bodies. The graft material acts as a binding medium – as the body heals, the vertebral bone and bone graft eventually grow together to join the vertebrae and stabilize the spine.

How Long Will It Take Me To Recover?

Your surgeon will have a specific postoperative recovery/exercise plan to help you return to your normal activity level as soon as possible. Following a lumbar laminectomy, you may notice an immediate improvement of some or all of your symptoms; other symptoms may improve more gradually.

The amount of time that you have to stay in the hospital will depend on your treatment plan. You typically will be up and walking in the hospital by the end of the first day after the surgery. Your return to work will depend on how well your body is healing and the type of work/activity level you plan to return to.

Work closely with your spinal surgeon to determine the appropriate recovery protocol for you, and follow his or her instructions “to the letter” to optimize the healing process.

To determine whether you are a candidate for a lumbar laminectomy, please talk to your doctor.

Are There Any Potential Risks Or Complications?

All treatment and outcome results are specific to the individual patient. Results may vary. Complications such as infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anesthesia, are some of the potential risks of spinal surgery. A potential risk inherent to spinal fusion is failure of the vertebral bone and graft to properly fuse, a condition that may require additional surgery.

Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to the lumbar laminectomy procedure.

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your health care professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your health care professional for diagnosis and treatment.

Unless Noted Otherwise, All Articles and Graphics Copyright ©2013, Medtronic Sofamor Danek, All Rights Reserved.
Please review our Privacy Policy, Editorial Policy, or Terms Of Use for more information.

A lumbar discectomy is a spine surgery that involves removing all or part of a diseased or damaged intervertebral disc to relieve pressure on the spinal nerve(s) in the lumbar spine, or lower back. In patients for whom it’s appropriate, this procedure may be performed using minimally invasive surgical techniques.

What Is A Minimally Invasive Lumbar Discectomy?

A lumbar discectomy is a surgical procedure that involves relieving the pressure placed on nerve roots and/or the spinal cord by a herniated disc or bone spurs in the lower back – a condition referred to as nerve root compression.

Lumbar refers to the five vertebrae of the lower back. Discs are the spongy, cartilaginous pads between each vertebra, and ectomy means “to take out.” In a lumbar discectomy, the surgeon accesses the lumbar spine through an incision in the back over the vertebral levels to be treated and removes all or part of the disc – and/or in some cases bone material – that’s pressing on the nerves and causing pain. Because it eliminates nerve/nerve root compression, a lumbar discectomy is considered a decompressive spinal procedure.

Depending on your condition and specific surgical goals, your surgeon may choose to perform this procedure using a minimally invasive approach.

Traditional, open spine surgery involves cutting or stripping the muscles from the spine. Minimally invasive spine surgery involves a small incision or incisions and muscle dilation, allowing the surgeon to separate the muscles surrounding the spine rather than cutting them.

Why Do I Need This Procedure?

A minimally invasive lumbar discectomy may be recommended to relieve pressure placed on the spinal cord or spinal nerves/nerve roots. In general, spine surgery is recommended when intervertebral disc or bone material is pressing into or pinching these neural elements and you are experiencing:

• Leg pain that limits your normal daily activities
• Weakness or numbness in your leg(s) or feet
• Impaired bowel and/or bladder function

How Is A Minimally Invasive Lumbar Discectomy Performed?

The Operation
The operation is performed with the patient positioned on his or her stomach.

Decompression
After a small incision is made, the muscles of the spine are dilated, or gently separated, and a tubular retractor is inserted to create a portal through which the surgeon may perform surgery. Through the tubular retractor, a portion of the lamina (the bony vertebral element that covers the posterior portion of the spinal canal) is removed to expose the compressed area of the spinal cord or nerve root(s).

Pressure is relieved by removing of the source of compression – all or part of a herniated disc, a rough protrusion of bone called a bone spur, or in some instances a tumor.

Closure
The small incision is closed, which typically only leaves behind a minimal scar.

How Long Will It Take Me To Recover?

Your surgeon will have a specific postoperative recovery/exercise plan to help you return to your normal activity level as soon as possible. Following a minimally invasive, you may notice an immediate improvement of some or all of your symptoms; other symptoms may improve more gradually.

The amount of time that you have to stay in the hospital will depend on your treatment plan. In some instances, this procedure may be done on an outpatient basis. You typically will be up and walking in the hospital by the end of the first day after the surgery. Your return to work will depend on how well your body is healing and the type of work/activity level you plan to return to.

Work closely with your spinal surgeon to determine the appropriate recovery protocol for you, and follow his or her instructions as closely as possible to optimize the healing process.

To determine whether you are a candidate for a minimally invasive lumbar discectomy, please talk to your doctor.

Are There Any Potential Risks Or Complications?

All treatment and outcome results are specific to the individual patient. Results may vary. Complications such as infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anesthesia, are some of the potential risks of spinal surgery. A potential risk inherent to spinal fusion is failure of the vertebral bone and graft to properly fuse, a condition that may require additional surgery.

Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to the minimally invasive lumbar discectomy procedure.

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your health care professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your health care professional for diagnosis and treatment.

Unless Noted Otherwise, All Articles and Graphics Copyright ©2013, Medtronic Sofamor Danek, All Rights Reserved.
Please review our Privacy Policy, Editorial Policy, or Terms Of Use for more information.

A posterior lumbar interbody fusion (PLIF) is a type of spine surgery that involves approaching the spine from the back, or posterior, of the body to place bone graft between two vertebrae. The procedure may be performed using minimally invasive surgical techniques.

What Is A Minimally Invasive PLIF?

Posterior lumbar interbody fusion (PLIF) is a type of spine surgery that involves approaching the spine from the back (posterior) of the body to place bone graft material between two adjacent vertebrae (interbody) to promote bone growth that joins together, or “fuses,” the two structures (fusion). The bone graft material acts as a bridge, or scaffold, on which new bone can grow. The ultimate goal of the procedure is to restore spinal stability.

Today, a PLIF may be performed using minimally invasive spine surgery, which allows the surgeon to use small incisions and gently separate the muscles surrounding the spine rather than cutting them. Traditional, open spine surgery involves cutting or stripping the muscles from the spine. A minimally invasive approach preserves the surrounding muscular and vascular function and minimizes scarring.^{1, 2}

Why Do I Need This Procedure?

A spinal fusion procedure such as a PLIF may be recommended as a surgical treatment option for patients with a condition causing spinal instability in their lower back, such as degenerative disc disease, spondylolisthesis or spinal stenosis, that has not responded to conservative treatment measures (rest, physical therapy or medication). The symptoms of lumbar spinal instability may include pain, numbness and/or muscle weakness in the low back, hips and legs.

Your surgeon will take a number of factors into consideration before recommending a PLIF, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. Please discuss this treatment option thoroughly with your spinal care provider.

How Is Minimally Invasive Lumber Interbody Fusion Performed?

Spinal Access and Bone Removal

First, your surgeon will make a small incision in the skin of your back over the vertebra(e) to be treated. Depending on the bone graft to be used, the incision could be as small as approximately 3 centimeters. In a traditional open PLIF, a 3- to 6-inch incision is typically required.

The muscles surrounding the spine will then be dilated to allow access to the section of spine to be stabilized. After the spine is accessed, the lamina (the “roof” of the vertebra) is removed to allow visualization of the nerve roots. The facet joints, which are directly over the nerve roots, may be trimmed to give the nerve roots more room.

Bone Graft Placement

The nerve roots are then moved to one side and disc material is removed from the front (anterior) of the spine. Bone graft is then inserted into the disc space. Screws and rods are inserted to stabilize the spine while the treated area heals and fusion occurs.

Your surgeon will then close the incision, which typically leaves behind only a small scar or scars.

How Long Will It Take Me To Recover?

This minimally invasive procedure typically allows many patients to be discharged the day after surgery; however, some patients may require a longer hospital stay. Many patients will notice immediate improvement of some or all of their symptoms; other symptoms may improve more gradually.

A positive attitude, reasonable expectations and compliance with your doctor’s post-surgery instructions all may contribute to a satisfactory outcome. Many patients are able to return to their regular activities within several weeks.

To determine whether you are a candidate for minimally invasive surgery, talk to your doctor.

Are There Any Potential Risks Or Complications?

All treatment and outcome results are specific to the individual patient. Results may vary. Complications such as infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anesthesia, are some of the potential risks of spinal surgery. A potential risk inherent to spinal fusion is failure of the vertebral bone and graft to properly fuse, a condition that may require additional surgery.

Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to a minimally invasive PLIF procedure.

¹ Stevens KJ, Spenciner DB, Griffiths KL, Kim KD, Zwienenberg-Lee M, Alamin T, Bammer R. Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies. J Spinal Disord Tech. 2006 Apr;19(2):77-86.

² Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery. 2002 Nov;51(5 Suppl):S146-54.

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your health care professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your health care professional for diagnosis and treatment.

Unless Noted Otherwise, All Articles and Graphics Copyright ©2013, Medtronic Sofamor Danek, All Rights Reserved.
Please review our Privacy Policy, Editorial Policy, or Terms Of Use for more information.

Posterolateral lumbar fusion is spine surgery that involves placing bone graft between elements in the back, or posterior, of the spine, leaving the disc space intact. The procedure may be performed using minimally invasive surgical techniques.

What Is Posterolateral Lumbar Fusion?

A posterolateral fusion operation is similar to a posterior lumbar interbody fusion (PLIF); however, instead of removing the disc space and replacing it with a bone graft, the disc space remains intact and the bone graft is placed between the transverse processes in the back of the spine. This allows the bone to heal and stabilizes the spine from the transverse process of one vertebra to the transverse process of the next vertebra.

In a posterolateral fusion, pedicle screws and rods also may be implanted to stabilize the spine until the bone graft heals. A single-level fusion fuses two vertebrae and usually uses four screws and two rods. A two-level fusion fuses three vertebrae and uses six screws and two rods.

Traditional, open spine surgery involves cutting or stripping the muscles from the spine. Today, a posterolateral fusion can be performed using minimally invasive spine surgery, a treatment that involves a smaller incision and muscle dilation, allowing the surgeon to gently separate the muscles surrounding the spine rather than cutting them.

Why Do I Need This Procedure?

A posterolateral fusion may be recommended as a surgical treatment option for patients with a condition causing spinal instability, such as degenerative disc disease, spondylolisthesis or spinal stenosis, that has not responded to conservative treatment measures (rest, physical therapy or medication). The symptoms of spinal instability may include pain, numbness and/or muscle weakness.

Your surgeon will take a number of factors into consideration before recommending posterolateral fusion, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. Please discuss this treatment option thoroughly with your spinal care provider.

How Is Posterolateral Lumbar Fusion Performed?

The Operation

The operation is performed with the patient positioned on his or her stomach.

Spinal Access and Bone Removal

First, your surgeon will make a small incision in the skin of your lower back. Depending on the instrumentation to be used, the incision could be as small as approximately 3 centimeters. In a traditional posterolateral fusion, a 3- to 6-inch incision is typically required.

The muscles surrounding the spine will then be dilated to allow access to the section of spine to be stabilized. After the spine is accessed, the lamina (the “roof” of the vertebra) is removed to allow visualization of the nerve roots. The facet joints, which are directly over the nerve roots, may be trimmed to give the nerve roots more room.

A bone graft is then laid between the transverse processes in the back of the spine. Screws and rods are implanted to stabilize the spine while the treated area heals and fusion occurs.

Your surgeon will then close the incision, which typically leaves behind only a small scar or scars.

How Long Will It Take Me To Recover?

This minimally invasive procedure typically allows many patients to be discharged the day after surgery; however, some patients may require a longer hospital stay. Many patients will notice immediate improvement of some or all of their symptoms; other symptoms may improve more gradually.

A positive attitude, reasonable expectations and compliance with your doctor’s post-surgery instructions all may contribute to a satisfactory outcome. Many patients are able to return to their regular activities within several weeks.

To determine whether you are a candidate for minimally invasive surgery, talk to your doctor.

Are There Any Potential Risks Or Complications?

All treatment and outcome results are specific to the individual patient. Results may vary. Complications such as infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anesthesia, are some of the potential risks of spinal surgery. A potential risk inherent to spinal fusion is failure of the vertebral bone and graft to properly fuse, a condition that may require additional surgery.

Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to minimally invasive posterolateral lumbar fusion.

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your health care professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your health care professional for diagnosis and treatment.

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Spinal fusion is a surgical procedure that involves placing bone graft material between adjacent vertebrae to promote bone growth that joins together, or �fuses,� the two structures. In patients for whom it�s appropriate, the procedure may be performed using minimally invasive surgical techniques.

What is Spinal Fusion Surgery?

Spinal fusion is a surgical technique in which one or more of the vertebrae of the spine are joined together (fused) to stop them from moving against each other. This is done by placing bone grafts or bone graft substitutes between the affected vertebral bone. The graft material acts as a binding medium and also helps to maintain normal disc height – as the body heals, the vertebral bone and bone graft eventually grow together to join the vertebrae and stabilize the spine.

Why Do I Need This Procedure?

There are a number of reasons your surgeon may recommend spinal fusion. This procedure is frequently used to treat:

• One or more fractured (broken) vertebrae
• Spondylolisthesis (slippage of one vertebral bone over another)
• Abnormal curvatures of the spine, such as scoliosis or kyphosis
• Protruding or degenerated discs (the cartilaginous “cushions” between vertebrae)
• Instability of the spine (abnormal or excessive motion between two or more vertebrae)

Spinal fusion is typically recommended only after conservative treatment methods fail. Your surgeon will take a number of factors into consideration before making this recommendation, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. If you are considering spinal fusion, please discuss this treatment option thoroughly with your spinal care provider.

How Is Spinal Fusion Performed?

There are a variety of surgical approaches and procedures, but all involve the placement of bone graft material between vertebrae. The graft material may be bone – either taken from the patient (autograft) or from a bone bank (allograft) – or a synthetic bone substitute called bone morphogenetic protein (BMP).

The spine may be approached and the graft positioned either from the back (Posterior Lumbar Interbody Fusion [PLIF]), the front (Anterior Lumbar Interbody Fusion [ALIF]) or the side (Tranforaminal Lumbar Interbody Fusion [TLIF]). Your surgeon also may decide that more than one approach is necessary. Please discuss your fusion approach options thoroughly with your surgeon, and rely on his or her judgment about which is most appropriate for your particular condition.

Instrumentation, such as screws, plates and cages, may be used to create an “internal cast” to support the vertebral structure during the healing process.

Spinal Fusion: Traditional vs. Modern Approach

Traditionally, surgeons have performed spinal fusion as an open procedure, which involves making an incision, stripping bands of muscle and retracting muscle and tissue for a clear view of the spine and easy access to the vertebrae for implantation.

Traditionally, autograft has been “the gold standard” in graft material. However, removal of the bone – usually from the patient’s pelvis or iliac crest – can be very painful. Allograft does not require this extra procedure, but healing often is not as predictable as with the patient’s own bone. BMP, a genetically produced protein, prompts the patient’s own bone cells to make more bone.

Modern spinal fusion can employ less invasive surgical techniques, such as muscle dilation, making the highly invasive posterior fusion approach unnecessary in many cases.

Muscle dilation is achieved by using a series of sequential dilators, or tubes to separate the fibers of the back muscles and create a small tunnel, enabling the surgeon to view the spine through an incision less than an inch long and leaving the muscle virtually intact. Advances in instrumentation allow rods and screws to be inserted via tiny incisions in the skin.

How Long Will It Take Me To Recover?

The recovery period for spinal fusion will vary depending on the procedure and your body’s ability to heal and firmly fuse the vertebrae together.

Patients typically stay in the hospital for several days, longer if necessary for more extensive surgery. This may also include time in a rehabilitation unit. Your surgeon will prescribe pain medication as needed, and may recommend a brace and follow-up physical therapy.

The length of time you will be off work will depend on a number of factors: your particular fusion procedure and the physician’s approach to your spine, the size of your incision, and whether or not you experienced any significant tissue damage or complications. Another consideration is the type of work you plan to return to. Typically, you can expect to be on medical leave for 3 to 6 weeks.

Work closely with your spinal surgeon to determine the appropriate recovery protocol for you, and follow his or her instructions to optimize the healing process.

Are There Any Potential Risks Or Complications?

All treatment and outcome results are specific to the individual patient. Results may vary. Complications such as infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anesthesia, are some of the potential risks of spinal surgery. A potential risk inherent to spinal fusion is failure of the vertebral bone and graft to properly fuse, a condition that may require additional surgery.

Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to a spinal fusion procedure.

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your health care professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your health care professional for diagnosis and treatment.

Unless Noted Otherwise, All Articles and Graphics Copyright ©2013, Medtronic Sofamor Danek, All Rights Reserved.
Please review our Privacy Policy, Editorial Policy, or Terms Of Use for more information.

A transforaminal lumbar interbody fusion (TLIF) is a type of spine surgery that involves approaching the spine from the back, or posterior, of the body to place bone graft between two vertebrae. The procedure may be performed using minimally invasive surgical techniques.

What Is A Minimally Invasive TLIF?

Transforaminal lumbar interbody fusion (TLIF) is a form of spine surgery in which the lumbar spine is approached through an incision in the back. The name of the procedure is derived from: transforaminal (through the foramen), lumbar (lower back), interbody (implants or bone graft placed between two vertebral bodies) and fusion (spinal stabilization).

The TLIF is a variation of the posterior lumbar interbody fusion (PLIF), in that it provides 360-degree fusion, avoids anterior access and associated complications, decreases manipulation of neural structures, reduces damage to ligamentous elements, minimizes excessive bone removal, enhances biomechanical stability, and provides early mobilization.

Traditional, open spine surgery involves cutting or stripping the muscles from the spine. But today, a TLIF may be performed using minimally invasive spine surgery, a treatment that involves small incisions and muscle dilation, allowing the surgeon to gently separate the muscles surrounding the spine rather than cutting them. A minimally invasive approach preserves the surrounding muscular and vascular function and minimizes scarring. ^{1, 2}

Why Do I Need This Procedure?

A spinal fusion procedure such as a TLIF may be recommended as a surgical treatment option for patients with a condition causing spinal instability in their lower back, such as degenerative disc disease, spondylolisthesis or spinal stenosis, which has not responded to conservative treatment measures (rest, physical therapy or medication). The symptoms of lumbar spinal instability may include pain, numbness and/or muscle weakness in the low back, hips and legs.

Your surgeon will take a number of factors into consideration before recommending a TLIF, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. Please discuss this treatment option thoroughly with your spinal care provider.

How Is A Minimally Invasive TLIF Performed?

Spinal Access and Bone Removal
First, your surgeon will make a small incision in the skin of your back over the vertebra(e) to be treated. Depending on the instrumentation to be used, the incision could be as small as approximately 3 centimeters. In a traditional open TLIF, a 3- to 6-inch incision is typically required.

The muscles surrounding the spine will then be dilated to allow access to the section of spine to be stabilized. After the spine is accessed, the lamina (the “roof” of the vertebra) is removed to allow visualization of the nerve roots. The facet joints, which are directly over the nerve roots, may be trimmed to give the nerve roots more room.

Bone Graft Material Placement
The nerve roots are then moved to one side and the disc material removed from the front (anterior) of the spine. A bone graft is then inserted into the disc space. The bone graft material acts as a bridge, or scaffold, on which new bone can grow. Screws and rods are inserted to stabilize the spine while the treated area heals and fusion occurs, and the ultimate goal of the procedure is to restore spinal stability.

Your surgeon will then close the incision, which typically leaves behind only a small scar or scars.

How Long Will It Take Me To Recover?

This minimally invasive procedure typically allows many patients to be discharged the day after surgery; however, some patients may require a longer hospital stay. Many patients will notice immediate improvement of some or all of their symptoms; however, other symptoms may improve more gradually.

A positive attitude, reasonable expectations and compliance with your doctor’s post-surgery instructions all may contribute to a satisfactory outcome. Many patients are able to return to their regular activities within several weeks.

To determine whether you are a candidate for minimally invasive surgery, talk to your doctor.

Are There Any Potential Risks Or Complications?

All treatment and outcome results are specific to the individual patient. Results may vary. Complications such as infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anesthesia, are some of the potential risks of spinal surgery. A potential risk inherent to spinal fusion is failure of the vertebral bone and graft to properly fuse, a condition that may require additional surgery.

Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to a minimally invasive TLIF procedure.

¹ Stevens KJ, Spenciner DB, Griffiths KL, Kim KD, Zwienenberg-Lee M, Alamin T, Bammer R. Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies. J Spinal Disord Tech. 2006 Apr;19(2):77-86.

² Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery. 2002 Nov;51(5 Suppl):S146-54.

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your health care professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your health care professional for diagnosis and treatment.

Unless Noted Otherwise, All Articles and Graphics Copyright ©2013, Medtronic Sofamor Danek, All Rights Reserved.
Please review our Privacy Policy, Editorial Policy, or Terms Of Use for more information.