Spinal fusion with decompression of the nerve roots can be the best option for patients who have spinal arthritis and nerve compression. Fusion can eliminate incapacitating low-back pain. Surgeons use current technology to make small incisions and perform the necessary nerve decompression and bone fusion.
Microscopic Lumbar Discectomy
Microscopic lumbar discectomy is a procedure that can be performed as outpatient surgery or as inpatient surgery with a one-night stay in the hospital. The minimally invasive procedure involves making a 1-inch incision so the surgeon can remove the disc fragment causing the pain. A smaller incision leads to less blood loss, decreased postoperative pain and a quicker recovery.
Minimally Invasive Lateral Interbody Fusion (XLIF and DLIF)
This newly developed fusion procedure is meant for patients who have degenerative disc disorders, or abnormalities in the vertebral structure that limit movement or cause pain. It can also be used to treat conditions where one vertebra slips over another, or when disc degeneration pinches the nerves that exit the spinal cord. XLIF (eXtreme Lateral Interbody Fusion) and DLIF (Direct Lateral Interbody Fusion) both use small incisions on the side (lateral) of the body to access the spine, and thus can only be used for vertebra that can be reached from the side. These are generally 60- to 90-minute procedures. Most patients are able to get up and walk about within a few hours of the surgery, and some patients report returning to work within a few weeks.
Minimally Invasive Posterior Lumbar Interbody Fusion (PLIF)
The PLIF procedure is used to access the lumbar spine, the second lowest region of the spine, just above the sacrum, to relieve pain and discomfort from degenerative or herniated disc disorders. PLIF is also used to reposition vertebra that have slipped out of normal alignment. PLIF uses two small incisions on either side of the lower back to access the spine, and generally takes 3 to 3½ hours to complete. Patients who have undergone PLIF benefit from quicker recovery and bone fusion times, with less blood loss during surgery and a reduced need for narcotic pain medication after surgery.
Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF)
Minimally invasive transforaminal lumbar interbody fusion is a technique used in the lower (lumbar) spine to treat herniated discs, degenerative disc disease, or vertebra that have slipped over one another. It is used in patients who continue to have problems after disc procedures called laminectomies, which involves trimming a bony section of the vertebra called the lamina. TLIF can also be used to treat spinal injuries and a condition called pseudoarthrosis. The name refers to a "false joint" that results from either an inborn error, or from an unsuccessful fusion procedure. "Transforaminal" refers to the foramen, which is the opening in the vertebra through which the spinal nerve passes as it exits the spinal cord. TLIF uses one incision to gain access to the spine, just a few inches away from the middle of the back. Compared with open surgeries, TLIF causes less blood loss during surgery, and results in a shorter hospital stay as well as a reduced need for narcotic pain medication after surgery. TLIF generally takes 2½ hours to perform.
Minimally Invasive Posterior Thoracic Fusion
Minimally invasive posterior thoracic fusion is performed in both the lumbar (lower back) and in the region of the spine located just above the lumbar, called the thoracic spine. The procedure is used to treat spinal injuries or deformities, spinal tumors, and infection. Open surgeries in the thoracic spine are difficult and can cause surgery-related complications, thus minimally invasive approaches are preferred when it is possible to use them. The posterior thoracic approach uses an incision in the middle of the back, and requires x-ray imaging and monitoring to help place instruments in their proper positions. The muscles in this area of the back are also bulkier than in the lower spine and must be held aside with retractors. This procedure can take 3 hours or longer to perform, depending on the complexity of the spinal disorder.
Scoliosis and Kyphosis Surgery
Scoliosis is the condition of lateral, or side-to-side, spinal curves. On an X-ray, the spine of a scoliosis patient looks more like an "S" or a "C" than a straight line. A normal spine curves gently backward (kyphosis) in the upper back and gently inward in the lower back (lordosis). Some of the bones in a scoliotic spine may also be slightly rotated, causing a difference in the person's shoulder height when standing, a prominence in one part of the back of the chest (thorax) or a prominence in the lower back when standing or bent over. The degree of scoliosis may range from mild to severe.
Recent advances in surgery have allowed surgeons to use minimally invasive techniques to perform scoliosis surgery. Video-assisted thoracoscopic surgery (VATS), involves the use of a thoracoscope in combination with a tiny video camera. The camera is introduced into the body though small incisions of 1 to 4 inches or less and enables the surgeon to perform spinal fusion from the front of the spine. VATS results in less blood loss than traditional scoliosis surgery, which uses a 6- to 8-inch incision, less postoperative discomfort and less scarring.