Regis W. Haid, Jr., MD, Spine Surgeon
A number of surgical techniques exist for the accomplishment of lumbar fusion. The procedure selected will vary based on your diagnosis, your symptoms, and other factors.
Some of the reasons you may require a lumbar fusion include:
While in many instances "open" techniques are still preferred, more and more conditions can now be surgically treated using new techniques called minimally invasive spine surgery. Dr. Haid will always assess the suitability of a minimally invasive technique for each patient.
What is minimally invasive spine surgery?
As the name suggests, minimally invasive spine surgery involves the surgeon making smaller incisions in the skin and avoiding large muscle retraction where ever possible. The surgeon uses small, thin instruments. A tiny video camera and light are connected to the endoscope and send images from "inside" the body to a screen in the operating room so the surgeon can observe the progress. Additional small tubes are then inserted through other small incisions. Special minimally invasive surgical instruments are then inserted through these tubes and used to perform the surgical procedure. (more about Minimally Invasive Spine Surgery)
Principal Types of Fusion
In all cases, disc material is removed from the spine and replaced with bone graft, as well as screws, cages, or rods if necessary.
ALIF - Anterior Lumbar Interbody Fusion.
This technique allows direct access to the degenerated disc without the necessity to move the spinal nerve roots. Better correction of the damaged disc is typically possible and the back muscles remain undisturbed. This approach is not suitable for treatment of spondylolisthesis or lumbar spinal stenosis as these are primarily posterior (on the back of the spine).
The incision is made on the front of the patient's body, typically 3-5 inches below the belly button.
PLIF - Posterior Lumbar Interbody Fusion
In this procedure, access to the spine is gained with an incision on the midline of the back.
TLIF - Transforaminal Lumbar Interbody Fusion
This is a refinement of the PLIF procedure and is generally preferred by Dr. Haid. In this case, the incision is still made on the midline of the back, but the approach to the spinal canal is more from the side. This approach greatly reduces the amount of surgical muscle dissection and minimizes the nerve manipulation required to access the vertebrae, discs and nerves.