Minimally Invasive Spinal Fusion Surgery in India - Best Spine Surgery Hospital India

Minimally Invasive SpinalFusion Surgery 

A person’s spine is subjected to a lot of forces throughout its lifetime. It may be subjected to age related wear and tear or infections like tuberculosis. As a result it undergoes degeneration which gives rise to a variety of problems like spinal osteoarthritis, disc prolapse, spondylolisthesis, osteoporotic fractures, vertebral collapse etc. All these conditions manifest as severe pain in the back and radiating pain, numbness, tingling in the upper or lower extremities (lower leg or arm) due to compression of spinal nerves,  spinal cord and spinal instability. When these symptoms become debilitating enough to preclude the patient’s day to day activity, a Spinal Fusion Surgery is advised.

What is Spinal Fusion Surgery?

The surgical procedure of spinal fusion (back fusion surgery) is performed to join one or more bony vertebrae of the spine permanently. This highly advanced procedure (disc fusion surgery) is an option for disability and pain in the spine which has been caused by some lesion and was not able to improve by other non surgical options such as medications or physiotherapy. Diseases, natural aging process and injuries are some of the causes for an unstable spine. These changes consents the abnormal movement of vertebrae and in turn the vertebrae starts to rub against each other. This can lead to either arm, back or leg pain. By fusing the vertebrae, it aligns and stabilizes the spine thereby maintaining the disc space in between the vertebrae. It saves from further damage of spinal cord and nerves.

When is Fusion Recommended

• Fracture
• Tumor
• Infection
• Spondylolisthesis
• Degenerative disc disease
• Scoliosis
• Spinal Stenosis

Types of Spinal Fusion Surgery

Lumbar spinal fusion can be divided into two categories-

Posterolateral Fusion : In the back of the spine, the bone graft is placed in amid the transverse processes. With the help of wires and screws, the vertebrae is carefully fixed throughout the particles of every vertebrae. A rod is made up of metal which is attached on the side of vertebrae.

Interbody Fusion : In this, the graft of the bone is placed in between the vertebrae and the area is generally engaged by the intervertebral disc. The disc is entirely removed in preparing for the spinal fusion. In order to maintain the disc height and spine alignment, a device can be placed in between the vertebrae. This device (intervertebral device) can either be prepared from titanium or plastic. Then the fusion starts in between the vertebrae’s endplates. Interbody fusion is of 3 types-

• Posterior Lumbar Interbody Fusion (PLIF)
• Transforaminal Lumbar Interbody Fusion (TLIF)
• Anterior Lumbar Interbody Fusion (ALIF)
• Transpsoas Interbody Fusion (XLIF or DLIF)

Posterior Lumbar Interbody Fusion (PLIF)

In Posterior lumbar interbody fusion, the spinal fusion is achieved through a surgical incision made on the posterior (back) aspect of spine. It aims at fusion of two adjacent vertebrae in cases of spinal instability and associated back pain. It is a popular procedure as it gives excellent results. The procedure provides almost complete relief of symptoms in 90-95% of the cases and the patients are able to return to their daily activities within a few weeks. The patients can also return to most of their recreational activities.

Procedure for Posterior Lumbar Interbody Fusion (PLIF)

PLIF surgery aims at achieving spinal stability through bony fusion by two ways:

The Open PLIF is the traditional technique which is performed using general anesthesia. The patient is made to lie down on his front side on the table with the low back exposed. A 3-6 inch long incision is made on the skin overlying the affected vertebrae. The skin and the fascia are cut open. The underlying muscles are retracted and the affected vertebrae are identified.  Fluoroscopic X-ray is used to confirm the exact location of the affected vertebrae. Then a complete laminectomy (removal of the lamina of the vertebrae) followed by bilateral foraminotomy (enlargement of the foramen by removing the bony spurs) and/or discectomy (removal of offending disc) are performed.

This relieves the compression off the spinal nerves, allowing them to come to their normal size and shape. The area is checked for any remaining bony outgrowth or disc fragments that may compress the nerves. Autogenic bone grafts or Metal or plastic implants are fitted in the empty disc space for initiating bone growth.

Minimally Invasive Posterior Lumbar Interbody Fusion (PLIF)

The other method is the Minimally Invasive PLIF procedure which is performed using x-ray guidance. 2.5-cm incisions are made on either side of the lower back

The muscles are gradually dilated and tubular retractors inserted to allow access to the affected area of the lumbar spine. The lamina is removed to allow visualization of the nerve roots. The offending disc material is removed from the spine and replaced with a bone graft and structural support from a cage made of bone, titanium, carbon-fiber, or a polymer, followed by placement of rod and screws. The tubular retractors are removed, allowing the dilated muscles to come back together, and the incisions are closed.

This procedure typically takes about 3 to 3 ½ hours to perform. There was less blood loss,tissue trauma, operative time, and quick recovery in this procedure as compared to the traditional one.Generally the patients can go home within 3-5 days after traditional PLIF and within 1-2 days after a minimally invasive PLIF

eXtreme lateral Interbody Fusion (XLIF)

The XLIF (eXtreme Lateral Interbody Fusion) is an approach to spinal fusion in which the surgeon accesses the intervertebral disc space and fuses the lumbar spine (low back) using a surgical approach from the side (lateral) rather than from the front (anterior) or the back (posterior).

The XLIF is one of a number of spinal fusion options that a surgeon may recommend to treat specific types of lumbar spinal disorders, such as lumbar degenerative disc disease, spondylolisthesis, scoliosis and deformity and some recurrent lumbar disc herniations and types of lumbar stenosis. It cannot be used for all types of lumbar conditions for which spinal fusion is a treatment option. For example, it cannot treat conditions at the lowest level of the spine, L5-S1 or for some people at L4-L5.

Spinal Fusion Surgery Benefits

This procedure can remove the pain as well as other symptoms. The advantages include-

• There are less chances of going through a surgery again when the level has been fused. In many cases, the facets or discs are pain producer and a fusion will make sure that the motion at the level is stopped by removing the lower back pain.
• The surgery drastically reduces the post-decompressive deformity. It has been seen that most patients have developed post-laminectomy kyphosis (abnormal alignment of the spine).
• Before the surgery, fusion can also correct the deformities of the patients so as to make sure the proper alignment of the spine is done.