Learn About The Spinal Lumbar Procedure
Lumbar discetomy is a common spinal lumbar procedure performed today. After a small incision over the lumbar segment that has the herniation, a small opening is made in the bone of the spine (called a laminotomy). The spinal sac and nerve are visualized, gently retracted, then the disk herniation is located and removed.
Bone spurs (ie spinal stenosis) can be removed by doing a laminotomy and foraminotomy. This involves resection of the medial lamina and the facet joint.
Laminectomy is a commonly performed spinal lumbar procedure to treat spinal stenosis. The procedure involves resection of the spinous process, lamina, and mesial (most midline portion) facet joints. In addition, foraminotomy is also performed. If required, a diskectomy can be simultaneously done to treat a disk herniation. Laminectomy can also be done when spine tumors need to be removed. Although an excellent procedure to treatment of certain disorders, Laminectomy does carry the risk of facet injury and spinal instability.
Lumbar fusion means fusing across the disk space and facet joints of the lumbar (or thoracic) vertebra. Fusion across the disk space is accomplished by either a TLIF, XLIF, or PLIF approach. Then, instrumentation (titanium rods and pedicle screws) is inserted in order to stabilize the spine while the fusion heals over 2-3 months. Often the hardware can be inserted through a minimally invasive percutaneous approach as described in the attached animation of the Longitude pedicle screw system.”
Trans-foraminal Lumbar Interbody Fusion
Direct lateral interbody fusion (DLIF)
DLIF or XLIF (Lateral Interbody Fusion) is another way to do a lumbar fusion. Instead of inserting a PEEK allograft via a posterior approach (like in TLIF or PLIF), the allograft is implanted laterally (through the right or left side of the disk space). This spinal lumbar procedure can only be performed at L4/5 or higher levels and requires dissection through the psoas muscle. After the diskectomy and placement of the DLIF or XLIF graft, instrumentation is then usually put in (either via a lateral titanium plate or posterior pedicle screws).
Anterior lumbar interbody fusion (ALIF)
As opposed to TLIF and XLIF, ALIF fusions are done from the front (anterior through an abdominal incision). After making an incision at or below the belly button, the abdominal contents (intestine, ureters, iliac arteries and veins) are moved to the side and the disk space removed. Then, an allograft or autograft are inserted. Often a titanium plate and screws are then put in or posterior pedicle screws are inserted through another incision (a 360 degree fusion).
Posterior lumbar interbody fusion (PLIF)
Trans-Foraminal Interbody Fusion (TLIF) or Posterior Lumbar Interbody Fusion (PLIF) are both posterior methods to do a lumbar fusion. Both procedures require a laminotomy (or laminectomy), diskectomy with subsequent insertion of an allograft (either cadaver or PEEK) and/or autograft (bone from the patient’s own body) into the disk space. Over time, the 2 lumbar segments fuse and become one segment. Instrumentation (usually titanium pedicle screws) is often inserted to help stabilize the segment while the fusion heals.
Artificial disk replacement
ADR is placed through an exposure similar to the ALIF. Instead of putting in a graft for fusion, an artificial disk is implanted. The two currently FDA approved ADRs are Charite and ProDisc. Both of these artificial disks have the potential to maintain motion at the implanted segment.
Kyphoplasty is a type of spinal lumbar procedure used to treat painful fractures of the lumbar and thoracic spine. Typically, compression fractures are due to osteoporosis, but tumor induced fractures can also be treated using this procedure. The procedure is usually done as an outpatient and involves injection of PMMA cement into the fractured vertebral body. Vertebroplasty is a competing technology that also is used to treat similar fractures. However, many published studies have shown a lower rate (and hence safer profile) of cement leakage out of the injected vertebra with kyphoplasty.
X-STOP is a lumbar spinous process distraction device that is used to treat lumbar spinal stenosis. The device is an “indirect” decompression device that relies on distraction between the lumbar vertebra in order to open the spinal canal and hence decompress the spinal nerves. In one well designed study, the device has been compared against and been shown to be more effective than conservative care (therapy, medications, and epidural steroid injections). However, X-STOP has not been directly compared with microdecompression surgery. In addition, X-STOP is indicated in patients with mild to moderate stenosis symptoms whereas microdecompression surgery is better for patients with severe symptoms).
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