BACKGROUND - Why was the XLIF procedure developed?
Spinal fusion has been used successfully for over fortyfive years to address a variety of conditions of the lumbar spine, including degenerative disc disease (DDD - which can cause recurrent herniation – or protrusion – of one or more discs between the vertebrae in the spinal column). The protrusion or bulge presses on the nerve roots in the spine, leading to extreme pain. A common strategy is to remove the bulging disc and fuse the vertebrae together with bone grafts that stabilize the area. Once you and your physician have decided that you need fusion of your lumbar spine, you should realize that there are many different ways this procedure can be done. The choice of which technique is best for you is dependent on your spinal deformities.
Over the past decade, there have been dramatic improvements in the way that spinal fusion operations are performed. These newer techniques are often called Minimally Invasive Spinal (MIS) surgery. The goals of all these techniques remain the same, to achieve a lumbar fusion thus providing stability to the lumbar spine, and lessen the patient’s pain.
XLIF is a minimally invasive procedure that offers major advantages for both the patient and the surgeon. It requires a smaller incision and is less traumatic to the body’s normal tissues, resulting in a faster, less painful recovery.
Alternatively, with the anterior (frontal) approach to spinal surgery, surgeons must move bowels, blood vessels and any previous scar tissue to reach the operating site. This can be very risky, with the potential for tissue damage and bleeding. In men, there is also the possibility of damage to the nerves leading to erectile dysfunction. With the posterior (back) approach, a much larger incision is required and muscles must be cut, usually resulting in a much longer, more painful recovery. Traditionally, spinal fusion is performed as open surgery, and while it has been associated with a low complication rate and pain relief for 90% of patients, many patients report experiencing back pain and fatigue as a result of muscle loss that can occur following surgery.
XLIF - How the surgery is performed:
XLIF uses minimally invasive techniques which means the surgery is performed through small incisions, usually with the aid of microscopes or endoscopic visualization (very small devices or cameras designed for viewing internal portions of the body). The "inside" view of the patient's body is projected onto television screens in the operating room.
Minimally invasive spine surgery was developed from the desire to effectively treat disorders of the spinal discs with minimal muscle-related injury and with rapid recovery. Minimally invasive techniques offer several advantages including tiny scars instead of one large scar, minimal muscle-related injury, a shorter hospital stay (two to three days versus five to six), reduced post-operative pain, a shorter recovery period and the ability to return to work and daily activities much sooner.
During the XLIF procedure the lumbar spine is approached from the your side (laterally), your surgeon will use an X-ray to precisely position and locate the operative space. Next, your skin will be marked at the site where the two small incisions will be made. Your surgeon will use the latest instrumentation to access the spine in a minimally disruptive manner. The surgery is performed through a muscle that lies next to the lumbar spine known as the psoas muscle. Disc preparation is the next step. This is done by removing the disc tissue which will allow the bones to be fused together. Several X-rays will be taken during this stage to ensure the preparation is correct. Once the disc has been prepared, the surgeon will then place a stabilizing implant (an artificial graft) into the space to restore the disc height and enable the bones to fuse together. Once in position, a final X-ray will be taken to confirm correct implant placement. In the event that further stabilization is necessary, the surgeon may choose to insert additional screws, rods, or plates into the vertebrae.
For a single level XLIF procedure, the surgery can be usually be performed in about an hour. Most patients stay in the hospital for 24 hours following the procedure, and do not require a brace. Occasionally, weakness may be noticed while lifting your leg after surgery. This psoas muscle weakness should return to normal fairly soon after surgery.
Not everyone is a candidate for this surgery, once conservative (non-operative) treatments have failed, you should consult a surgeon to see if you are an appropriate candidate.
Because the incision is so much smaller and less trauma is done to other tissues in the body during surgery, blood loss is minimal and most XLIF patients are able to return home from the hospital within one to three days.
Review of benefits to patients:
- Less-invasive procedure allows for less tissue disruption
- Procedure provides relief to patients who have lived with back or leg pain through years of various failed treatments, including steroid injections, physical therapy, and pain medication
- Patients are typically walking the same day after surgery and require only an overnight stay in the hospital, compared to several days of immobility and hospitalization typical of traditional open approaches
- Rapid return to normal activity, typically weeks, compared to months
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