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Introduction to Lateral Lumbar Interbody Fusion
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Lateral Lumbar Interbody Fusion is a procedure of spinal fusion in which the surgeon accesses the intervertebral disc space and fuses the lumbar spine using a surgical approach from the side, rather than from the front or the back. The five vertebrae of the lower back, the lumbar spine bear the greatest amount of the body's weight, making them the most vulnerable to back pain. Degenerative conditions, congenital deformity and injury can lead to spinal instability if put pressure on the spinal cord and/or surrounding nerves, may gradually cause back pain and other symptoms such as leg pain or muscle weakness that extends into the hips, buttocks and legs. Spinal fusion is sometimes recommended to treat conditions of the lower back. The goal of a spinal fusion procedure is to restore spinal stability, and the procedure usually involves removal of the disc material from in between two adjacent vertebrae and then placing an implant and bone graft material into the disc space to promote bone growth that permanently joins together the two vertebrae. Rods and screws are then placed posteriorly to support the vertebral structure during the healing process. 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, the doctor’s own training and surgical experience, available technology and the patient's overall general health. To a great extent, smoking causes more rapid degeneration of the spine, and continuing to smoke increases the likelihood of requiring treatment at another level of the spine.
Procedure of Lateral Lumbar Interbody Fusion
After you have been positioned, an x-ray will be taken to help your doctor precisely locate the operative space. Next, the skin will be marked at the site where two small incisions are to be made. The surgeon will use the latest instrumentation to access the spine in a minimally disruptive manner. Disc preparation is the next step. It is done by removing the disc tissue, which allows the bones to be fused together. Several x-rays are taken during this stage to ensure that the preparation is correct. Once the disc has been prepared, the surgeon will then place a stabilizing implant into the space to restore the disc height and enable the spine to once again support necessary loads. 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.
Flouroscope, a type of real-time x-ray machine is used in the operating room which ensures proper positioning of the vertebra to be treated. The doctor makes a 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 multi-level fusion. A fluoroscopic guidance is used while inserting a series of tubular dilators through the soft tissues and fibers of the muscle to create a tunnel through which the surgeon may view the spine and perform surgery. After this, he removes the part of the affected disc and then prepares the bone surfaces of the adjacent vertebrae for fusion, inserts an interbody device and bone graft into the disc space to promote fusion and then he finally removes the tubular portal and closes the incision.
Advantages of Lateral Lumbar Interbody Fusion
- Minimal tissue damage
- Lesser blood loss
- Small incisions and scars
- Minimum post-surgical discomfort
- Quick recovery time.
Risks of the Surgery
- Surgery and anesthesia may cause stress to many organs and tissues.
- On rare occasions, the bone graft does not heal correctly.
- Increased smoking or use of nicotine of any kind may also hamper healing procedure. It can cause the hardware to fail, and the bone graft may shift. For high risk patients, doctors may check urine for nicotine by-products to ensure no tobacco is in the system prior to surgery.
- Dural Tear: Leakage of spinal fluid can occur due to a tear in the tissue holding the spinal fluid and containing the nerves.
- Infection: is always a post-operative risk which may be superficial or deep inside the bone.
- Pneumonia, blood clots and complications related to the general anesthesia.
- Persistent hoarseness and/or swallowing problems may last for several weeks.