PATIENT INFORMATION
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A Study Investigating Minimally Disruptive Motion Preservation for the Lumbar Spine. Learn more about this patient research study here.
Procedures
Surgical Treatment Options | Interbody Fusion Techniques | XLIF® (eXtreme Lateral Interbody Fusion)
Maximum Access Surgery | Nerve Avoidance Technology | Fusion
Surgical Treatment Options
Once your doctor has recommended spine surgery, the next step is deciding which surgical procedure is appropriate for you. Surgery to reduce pain and restore function to the back sometimes requires stabilization of two vertebrae. This is done to reduce motion between the joints, adjust alignment, and restore disc height. This type of procedure is called an interbody fusion and generally speaking, is defined by the “approach,” or the way in which the surgeon accesses the spine.
Interbody Fusion Techniques
Treatment alternatives for low back pain include conservative care (e.g., rest, heat, analgesics, physical therapy) and surgical treatment, including laminectomy, disc resection and other types of nerve root decompression, and fusion. The intent of fusion is to restore disc space height, alignment, and stability. There are a number of ways to approach the spine.
Traditionally, there are a few ways to fuse the spine. One of these ways is known as interbody fusion, which is fusion of two vertebrae between the vertebral bodies (main trunk of the vertebrae) in the anterior column (front part of the spine). In order to fuse two vertebrae together using interbody fusion, the intervertebral disc must first be removed. In the space created by the removal of the disc, an implant, such as a spacer or cage, will be inserted to help maintain the normal alignment of the spine. Additionally, bone graft (real pieces of bone used to stimulate bone growth) or bone graft substitute (natural or synthetic material used to replace bone tissue and stimulate bone growth) is placed in the space made between neighboring vertebrae to help them fuse together.
In some cases, for additional stability, it will be necessary for your surgeon to implant screws, plates, or rods into the vertebrae to hold them in place.
XLIF® (eXtreme Lateral Interbody Fusion): With this procedure, the spine is approached from the side of the body. With the patient positioned on the surgical table on the side, two small incisions are made: one directly over the side of the waist, and the other slightly behind the first.
The advantages of this approach are that it does not require dissection of the sensitive back muscles or bones, or the retraction of nerves, and allows for more complete disc removal and predictable implant insertion, compared with PLIF or TLIF. Nor does it require the delicate abdominal exposure or removal of the front ligament, or present the same risk of vascular injury as an ALIF procedure.
By allowing greater access to the disc space, a larger implant can be used, which indirectly decompresses nerves by restoring disc height and spine alignment.
It is important that you discuss the potential risks, complications, and benefits of XLIF® 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.
Maximum Access Surgery
MAS® is
a unique NuVasive® technology that combines tools
for accessing the spine with implants for resolving spine problems.
The MaXcess® System provides customized maximum surgical access while minimizing the soft tissue disruption that often occurs during open surgery. As opposed to “minimal access systems,” which provide minimal spinal access, minimal visualization, and minimal surgical confidence, the MaXcess System from NuVasive offers customized access and improved visualization for positioning instruments and implants. Additionally, since there are no adjunctive visualization tools (e.g., endoscope, monitor), the MaXcess System enables direct illuminated visualization of the patient's anatomy through conventional methods. This provides the surgeon all the benefits of a minimally disruptive surgical approach without compromising conventional surgical techniques.
Combined with NeuroVision,® MaXcess provides the surgeon with accurate, real-time feedback about nerve health, location, and function during surgery. Together, they create the opportunity for dramatically less disruptive spine procedures.
Nerve Avoidance Technology
During spine surgery, it is important to protect the nerves associated
with the spinal column. These nerves carry messages to and from
the brain, organs, and limbs, aiding them with proper movement and sensation.
The NeuroVision Intraoperative Monitoring System provides real-time, precise, and reliable feedback to ensure nerve and spinal cord safety. By using this unique and advanced technology, the surgeon is provided with intraoperative information about the location and function of the nerves, assisting with safe implant placement and surgical technique during minimally disruptive spine procedures.
Indications for Use
The NeuroVision® System is intended for use in the operating room and non-critical care clinical environment for neurological monitoring and status assessment. The System may be used alone or in conjunction with other NuVasive devices to assist in gaining controlled access to the spine.
It is important that you discuss the potential risks, complications, and benefits of the NeuroVision System 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.
Talk to your doctor to learn more about the NeuroVision System. Or, use the Physician Locator on www.lateralaccess.org to search for a SOLAS™ surgeon in your local area.
Fusion
Traditionally, there are a few ways to fuse the spine. One of these ways is known as interbody fusion, which is fusion of two vertebrae between the vertebral bodies (main trunk of the vertebrae) in the anterior column (front part of the spine). In order to fuse two vertebrae together using interbody fusion, the intervertebral disc must first be removed. In the space created by the removal of the disc, an implant, such as a spacer or cage, will be inserted to help maintain the normal alignment of the spine. Additionally, bone graft (real pieces of bone used to stimulate bone growth) or bone graft substitute (natural or synthetic material used to replace bone tissue and stimulate bone growth) is placed in the space made between neighboring vertebrae to help them fuse together.
In some cases, for additional stability, it will be necessary for your surgeon to implant screws, plates, or rods into the vertebrae to hold them in place.
ALIF (Anterior Lumbar Interbody Fusion):
ALIF uses an anterior approach to the lumbar spine to achieve intervertebral disc height and alignment restoration, as well as to achieve fusion. In this procedure, the spine is approached from the front of the body. This approach spares the back from trauma but requires delicate manipulation of the major blood vessels in front of the spine. Relative contraindications for anterior lumbar fusion include osteopenia, severe peripheral vascular disease, active infection, and obesity.
PLIF (Posterior Lumbar Interbody Fusion):
PLIF
was introduced in the 1950s, using grafts from the hip bone, following
removal of the intervertebral disc. This procedure is performed through
the middle back, which allows direct access to the area being treated.
The downside is that this approach requires significant disruption
to the muscles, bones, and ligaments of the back, which can lead to
pain and desensitization after surgery, as well as requires the surgeon
to work directly around nerves.
TLIF (Transforaminal Lumbar Interbody Fusion):
TLIF
is similar to PLIF - the difference being that only one side of
the back is accessed and affected. As with PLIF, significant disruption
to the muscles, bones, and ligaments of the back can occur. Although
most often limited to one side of the back, the TLIF procedure
can sometimes lead to pain and desensitization of the back muscles
after surgery. This procedure can also be performed minimally
disruptively, using novel access technology such as MaXcess.®
Thoracotomy:
This procedure approaches the thoracic spine from the side of the rib cage and requires a large incision and deflation of the lung.
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 healthcare 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 healthcare professional for diagnosis and treatment. Please use the Physician Locator on www.lateralaccess.org to find a SOLAS™ surgeon in your area.
Nate “Rock” Quarry is a paid spokesperson for NuVasive®, Inc.