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.

Posterior Lumbar Interbody Fusion (PLIF) Surgery in India | Best Spine Hospital India

Posterior Lumbar Interbody Fusion (PLIF) Surgery in India

A posterior lumbar interbody fusion (PLIF) is a type of spine surgery that can be performed in a minimally invasive way. Posterior lumbar interbody fusion (PLIF) is a type of spine surgery that involves approaching the spine from the back (posterior) of the body to place bone graft material between two adjacent vertebrae (interbody) to promote bone growth that joins together, or "fuses," the two structures (fusion). The bone graft material acts as a bridge, or scaffold, on which new bone can grow. The ultimate goal of the procedure is to restore spinal stability.

Today, a PLIF may be performed using minimally invasive spine surgery, which allows the surgeon to use small incisions and gently separate the muscles surrounding the spine rather than cutting them. Traditional, open spine surgery involves cutting or stripping the muscles from the spine. A minimally invasive approach preserves the surrounding muscular and vascular function, minimizes scarring, hastens recovery and decreases hospitalization stay.

How is it done?

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. Finally, pedicle screws are placed into the upper and lower vertebrae and connected with rods or plates. New bone is allowed to grow over these rods, helping to bridge the adjacent vertebrae and achieving interbody fusion. The total surgery time is approximately 3 to 6 hours, depending on the number of spinal levels involved.

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

Post-Operative Care after PLIF

Most patients are usually able to go home 3-5 days after surgery. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending at the waist, lifting (more than five pounds), and twisting in the early postoperative period (first 2-4 weeks) to avoid a strain injury. Patients can gradually begin to bend, twist, and lift after 4-6 weeks as the pain subsides and the back muscles get stronger.

Recovery from PLIF

Rehabilitation after PLIF can be a slow process. Many surgeons prescribe outpatient physical therapy beginning a minimum of six weeks after surgery. This delay is needed to make sure the graft has time to begin to fuse. You will probably need to attend therapy sessions for two to three months. You should expect full recovery to take up to eight months.

Cervical Disc Replacement Surgery in India | Best Spine Surgery Hospital India

Cervical Disc Replacement Surgery in India

This promising new procedure is a boon for all those suffering from severe and intractable neck pain. It has revolutionized the approach used for treating patients with severe longstanding cervical spondylitis, whiplash injuries, cervical disc prolapse, offering them a better quality of life. Also known as artificial disc replacement, this technique is fast becoming popular amidst surgeons and patients alike because of its excellent results. It is considered superior to cervical spine fusion surgeries as it maintains normal neck motion post operatively and ensures early return of patient to normal activities. In this procedure a stainless steel disc with a ball in trough design is inserted between the affected cervical vertebrae. This helps to simulate natural neck movements. The patient stays in the hospital for 1-2 days and resumes work in 45 days.

Working Anatomy of Cervical Spine

The cervical spine consists of 7 cervical vertebrae named C1, C2, C3, C4, C5, C6, C7 with shock absorbing intervertebral disc in between them. These discs allow for the smooth rotating and bending movements of the cervical spine. With age these discs lose their water content and get compressed between the vertebrae which may lead to herniation of disc contents. Along with this there is wear and tear of the vertebrae causing formation bony outgrowths known as (osteophytes). The prolapsed disc can compress the spinal cord within the spinal canal (myelopathy) or the exiting nerve roots at the intervertebral foramina (lateral openings between each vertebral pair) causing radiculopathy (radiating pain in the arm).

Objective of the Procedure

The cervical segments C4- C5, C5-C6, C6-C7 are more vulnerable to disc prolapse and spondylitis due greater mobility at these joints. Disc prolapse results in reduction of intervertebral distance which causes pressure on the exiting nerve roots at intervertebral foramina. Disc replacement surgery aims at reducing the symptoms of degenerative joint disease. Replacing the damaged disc with an artificial implant or prosthesis, restores the normal distance between the two vertebrae and relieves the pressure on the nerve roots.

Why is Cervical Disc Replacement Surgery required?

A large number of people nowadays face neck, shoulder and/ or pain in the arms mainly because of the abnormalities in the neck. These complaints can be signs of disc herniations or disc degeneration, and/or arthritis of the neck.

The cervical spine is composed of vertebral bodies and intervertebral discs. These discs wear out with time causing pain and other symptoms and are referred to as degenerative disc disease, a subgroup of which includes cervical disc herniations. This means the disc becomes compressed, frayed, and/or herniates into the adjacent spinal canal where it can press on nerves or the spinal cord.

Most patients with these types of symptoms do not need surgery and improve with conservative like anti-inflammatory medications, physical therapy, or cold/heat therapy. However, if a person continues to have significant neck pain and/or radicular arm pain, he or she may be a candidate for cervical spine surgery. An anterior discectomy and fusion is the most common operation for treating patients with symptoms related to a degenerative or herniated disc in the neck.

Cervical Disc Replacement Surgery- The Procedure

The procedure for cervical disc replacement surgery consists of removing the problem disc entirely and replacing it with a piece of bone taken either from the patient's hip and a metal plate with screws and/or a cervical collar may also be used to help hold the bone in place and to allow this segment of the neck to fuse together. The purpose of an anterior cervical discectomy and fusion surgery is twofold:

• To remove the offending agent—either the herniated disc or the osteophytes that are compressing the nerves and/or spinal cord.
• To eliminate motion by inducing a fusion at the disc space where the disc has been removed, aided by the use of bone grafts and possibly plates/screws, etc. and thereby creating stability and/or eliminating pain associated with the motion.

This type of surgery typically improves the pain in over 90% of people with one-level disease. However, there may be complications in using bone grafts in pursuit of a fusion. Harvest of one's own bone may be associated with both acute and potentially long-term pain from the donor site. Any type of bone graft may fail to heal, resulting in a so-called 'non-union', which may require another fusion operation.

Also, by fusing a segment of the spine, the levels of the spine above and below the fused area are now forced to absorb more load since there is no longer any intervening motion shock absorption. These adjacent levels will then wear out and become symptomatic in more than 25% of these patients within ten years, meaning possibly more surgery. This is called adjacent-segment degeneration.

The development of artificial cervical discs is intended to accomplish the same objectives as the traditional decompression and fusion surgery in terms of providing pain relief and stability, but with fewer drawbacks. For example, the cervical artificial disc does not include the potential complications involved with using bone graft (e.g. 'non-unions') and theoretically should lessen the risk of developing adjacent-segment disc degeneration or disease.

Post operative Recovery and Rehabilitation Period

The patient stays in the hospital for 1-2 days and resumes work in 45 days post operatively. Avoid bending neck backwards. A brace or soft collar may be recommended after the operation to support the neck muscles. Physical therapy may be prescribed 1-2 weeks after surgery which has to be done on outpatient basis. The therapy will initially start with pain relieving modalities such as ice, electrical stimulation to reduce pain followed by gentle active exercises. Gradually gentle stretching, strengthening and endurance exercises to the neck muscles are introduced. The therapist gives instructions on how to maintain the neck postures during various tasks of daily living. This is followed by a home exercise program.

Low Back Pain Treatment and Surgey in India

Low Back Pain Treatment

Pain or discomfort in the lower portion of our back and the spinal column is a common phenomenon and can be largely attributed to our changing lifestyles.

Wrong posture or inadequate exercise is most often the cause of the pain in the lower spinal column. The treatment of such a pain can vary from a simple over the counter medicine to surgery depending on the severity and the cause.

The pain is generally felt in the lumbar and the sacral region and can also affect other areas. A sprain in the muscles or the ligaments constituting the lower portion of the spine can be the most common cause of backache. Some of the other problems that involve pain in the lower back are disc degeneration due to arthritis or ageing, spondylitis, infections and tumors.

In most of the cases the pain is localized in the lower back and vanishes after some time. However, it may even extend to the buttock or the leg on the affected side. In cases wherein the pain is persistent and increases with time or results in weakness in the foot or loss of bladder control- proper medical check up becomes essential.

In some cases stiffness or persistent pain around the spine can disturb your sleep resulting in further problems like tiredness. Such problems can be rectified by the used of pillows designed to maintain our body posture and thus ensure proper sleep. The use of the wrong type of mattresses can also affect the body posture and result in back pain.

Lower back pain is one of the commonest problems afflicting people around the world at some point of time in their life.

In the initial stages of pain, stretching exercises work effectively as Lower Back Pain Treatment.

The lower back supports the upper body and allows the body to turn, twist, bend, lift and walk. It plays a very important role in mobility. The lower back takes a lot punishment, as we tend to overuse or misuse it.

There are many options available for Lower Back Pain Treatment, depending upon the problem.

Surgery is usually the last resort in the treatment of back pain. It is usually only recommended if all other treatment options have been tried or in an emergency situation. The main procedures used in back pain surgery are discectomies, spinal fusions, laminectomies, removal of tumors and Vertebroplasty.

There are different types of surgical procedures that are used in treating various conditions causing back pain. Nerve decompression, fusion of body segments and deformity correction surgeries are examples. The first type of surgery is primarily performed in older patients who suffer from conditions causing nerve irritation or nerve damage. Fusion of bony segments is also referred to as a spinal fusion and it is a procedure used to fuse together two or more bony fragments with the help of metalwork. The latter type of surgery is normally performed to correct congenital deformities or those that were caused by a traumatic fracture. In some cases, correction of deformities involves removing bony fragments or providing stability provision for the spine. A time-tested procedure to repair common intervertebral disc lesions which offers rapid recovery (just a few days) involves the simple removal of the fibrous nucleus of the affected intervertebral disc.

A discectomy is performed when the intervertebral disc have herniated or torn. It involves removing the protruding disc, either a portion of it or all of it by placing pressure on the nerve root. The disc material which is putting pressure on the nerve is removed through a small incision that is made over that particular disc. This is one of the most popular types of back surgeries and which also has a high rate of success. The recovery period after this procedure does not last longer than 6 weeks. The type of procedure in which the bony fragments are removed through an endoscope is called percutaneous disc removal.

Microdiscectomy may be performed as a variation of standard discectomies in which a magnifier is used to provide the advantage of a smaller incision, thus a shorter recovery process.

Spinal fusions are performed in cases in which the patient has had the entire disc removed or when another condition has caused the vertebrae to become unstable. The procedure consists in uniting two or more vertebrae by using bone grafts and metalwork to provide more strength for the healing bone. Recovery after spinal fusion may take up to one year, depending greatly on the age of the patient, the reason why surgery has been performed and how many bony segments needed to be fused.

In cases of spinal stenosis or disc herniation, laminectomies can be performed to relieve the pressure on the nerves. During such a procedure, the surgeon enlarges the spinal canal by removing or trimming away the lamina which will provide more space for the nerves. The severity of the condition as well as the general health status of the patient are key factors in establishing the recovery time, which may be range from 8 weeks to 6 months.

Back surgery can be performed to prevent the growth of benign and malignant tumors. In the first case, surgery has the goal of relieving the pressure from the nerves which is caused by a benign growth, whereas in the latter the procedure is aimed to prevent the spread of cancer to other areas of the body. Recovery depends on the type of tumor that is being removed, the health status of the patient and the size of the tumor.

Treatment Options for Scoliosis - Children Scoliosis Surgery in India

Scoliosis is a condition in which the spine—in addition to the normal front to back curvature—has an abnormal side-to-side “S-” or “C”-shaped curvature. The spine is also rotated or twisted, pulling the ribs along with it to form a multidimensional curve.
Three to five children out of every 1,000 develop spinal curves that are considered large enough to require treatment. Idiopathic scoliosis does tend to run in families, although no one genetic link has been confirmed.

Scoliosis occurs, and is treated, as three main types:

• idiopathic scoliosis: the most common form, with no definite cause, mainly affecting adolescent girls, but existing in three age groups:

• adolescent idiopathic scoliosis

• juvenile idiopathic scoliosis

• infantile (early-onset) idiopathic scoliosis

• neuromuscular scoliosis: associated with a neuromuscular condition such as cerebral palsy, myopathy or spina bifida
• congenital scoliosis: present at birth, caused by a failure of the vertebrae to form normally—the least common form

In general, curves measuring 25 to 50 degrees are considered large enough to require treatment. Curves greater than 50 degrees will likely need surgery to restore normal posture.

What will make the spine go back to being straight again?

A scoliosis curve will not get straight on its own. Bracing will help it from getting worse. Surgery — a spinal fusion — is the only thing that will straighten out the spine, but it will not make it completely straight.

What happens if my child has just a slight curve?
Children who have mild curves (less than 20 degrees) or who are already full grown, will be monitored to make sure the curve is not getting worse. Your doctor will check your child's spine every 6 months and schedule follow-up x-rays about once a year.

Will having so many x-rays cause future health problems?
X-rays are necessary to follow the progression of the curve. There can be small negative effects with frequent x-rays, but these effects are minimized by using protective shields over certain body parts to protect the child from unnecessary exposure.

What happens if no treatment is done? Will the curve get worse?
Two factors can strongly predict whether a scoliosis curve will get worse: young age and a larger curve at the time of diagnosis. Children younger than 10 years with curves greater than about 35 degrees tend to get worse without treatment.

Once someone is done growing, it is very rare for a curve to progress rapidly. We know from studies that once someone is fully grown, scoliosis less than 30 degrees tends not to get worse, while those curves greater than 50 degrees can get worse over time, by about 1 to 1 1/2 degrees per year.

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Spinal Fusion Benefits - Spinal Fusion Surgery in India

Spinal Fusion Surgery

Lumbar spinal fusion is a type of back surgery in which a bone graft is inserted in the spine so that the bones in a painful segment of the spine fuse together. The fusion aims to stop the motion at a vertebral segment, which should decrease the pain caused by the joint. After the surgery it will take several months (usually 3 to 6, but sometimes up to 18 months) before the fusion is set-up. This surgery has been improved over the last 10 to 15 years, allowing for better success rates, and shorter hospital stays and recovery time.

Indications and contraindications for spinal fusion

The vast majority of people with low back pain will not need fusion surgery and will be able to manage the pain primarily with physical therapy and conditioning. A fusion surgery may, however, be recommended for patients with: 

Before beginning the main part of a spinal fusion procedure, your surgeon will need to gather material for a bone graft, which is used later on to join the targeted spinal bones together. Depending on individual circumstances and your surgeon’s preferences, this graft material can come from bone harvested from one of your own hips or ribs, from bone harvested from a special donor cadaver, or from artificial materials such as plastics or ceramics.

Once the graft material is ready, your surgeon will make an incision and create an opening that exposes the site of the fusion. Potential locations of this incision include your abdomen, your back and the side of your neck or torso. After exposing the site of procedure and removing the spinal disc that sits between your spinal bones, your surgeon can place the bone graft in one of several ways. First, he can place the graft material directly into the empty space left by the removed spinal disc. Alternatively, he can place the graft material inside a device called a spacer or cage, then insert this device into the gap between your spinal bones. Your surgeon can also lay the graft material over the rear surfaces of the targeted spinal bones.

All of these techniques will lead to fusion of your bones and incorporation of the graft material by triggering your body’s natural healing process. Frequently, bone grafts are held in position by metal rods or plates and screws during this healing period.

Fusion surgery success rates vary between 70% and 95%, and there are several factors that will impact the success rate of the surgery, including:

·                     Low back pain caused by degenerative disc disease that limits the patient's ability to function (after non-surgical treatments, such as physical therapy and medication, have failed)

·                     Isthmic, degenerative or postlaminectomy spondylolisthesis

·                     A weak or unstable spine (caused by infections or tumors), fractures, or deformity (such as scoliosis)

Spinal Fusion Uses

Problems in your spinal column that can lead to a need for spinal fusion include a form of bone slippage called spondylolisthesis, debilitating forms of abnormal spinal curvature or deformity, and mechanical spinal instability caused by problems such as accidents or injuries. Surgeries that can produce enough spinal instability to require fusion as a follow-up procedure include complete or partial removal of a damaged spinal disc (discectomy) removal of all or part of the section of spinal bone that forms the back of the spinal canal (laminectomy); and widening of the gaps in your spinal column that allow nerves to pass through from your spinal cord (foraminotomy).

Spinal Fusion Benefits

The rigidity and stability provided by spinal fusion can prevent dangerous degrees of spinal motion, ease pain and other symptoms associated with unwanted or excessive spinal motion, and help prevent damage in the soft tissues situated near your spine. In the vast majority of cases, these benefits are either permanent or remain for extremely extended periods of time.

Success rates for fusion

·                     Spine fusion for conditions that arise from gross instability (e.g. isthmic or degenerative spondylolisthesis) tends to be more successful than surgery done for pain alone (e.g. degenerative disc disease).

·                     Individuals with only one badly degenerated disc (especially L5-S1) but an otherwise a normal spine tend to fare better than those undergoing multilevel fusions. Fusion surgery is generally considered for one or possibly two levels, and multilevel fusions should be avoided except in cases of severe deformity.

·                     Individuals who have significant disc degeneration usually find more pain relief from a fusion than those with only minor degeneration on the MRI scan (e.g. still have a tall disc).

The most important success factor in fusion surgery is confirming that a patient's back pain is truly caused by degenerative disc disease, rather than some other condition. This is done by a combination of a careful review of the patient's history, a physical exam, and diagnostic tests (such as x-ray and MRI), and/or possibly a discogram.

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Minimally Invasive Lumbar Fusion Surgery in India | Best Spine Surgery Hospitals in India

Lumbar fusion surgery is a procedure used to treat a variety of conditions of the lumbar spine (lower back). This article will focus on minimally invasive lumbar fusion, although open lumbar fusion incorporates some of the same steps. 

Minimally Invasive Lumbar Fusion Surgery

Lumbar fusion may be used to treat a variety of conditions. These include lumbar instability, spondylolisthesis, degenerated lumbar discs, back pain, fracture, tumor, recurrent herniated discs, and failed back syndrome, among others. The most common levels in the spine requiring treatment are L4-5 and L5-S1. Many patients requiring lumbar fusion surgery also have pinched nerves from herniated discs or spinal stenosis. As a result, the surgery is often performed in conjunction with micro lumbar discectomy or lumbar laminectomy. 

Lumbar spinal fusion is a common technique to help patients with back pain, who have failed non-operative treatment. 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 what is wrong with your spine. Your surgeon may have more experience with fusion techniques from the front of the spine (anterior), the back of the spine (posterior), or some of the newer, less invasive approaches. 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, and lessen the patient's pain.

The most common method of spinal fusion involves the posterior approach, with an incision along the back of the patient's spine. Often, this procedure is used if bone spurs, thickened ligaments, or disc ruptures need to be removed to alleviate pressure on the nerves. The fusion procedure then involves placement of metal screws, rods and bone graft. Anterior spinal fusions require an incision through the abdomen. After removal of the degenerated disc, a metal cage with bone graft is usually placed between the spinal bones (vertebral bodies). Some patients will require both front and back procedures.

There are many new surgical techniques that are being developed to improve the results of lumbar fusions. Minimally invasive spine surgery for lumbar fusion is one of these newer techniques. MIS procedures have smaller incisions, cause less trauma to the surrounding normal tissues, and hopefully results in a faster recovery for the patient. One of these MIS techniques is a procedure known as extreme-lateral lumbar interbody fusion (XLIF). During the XLIF procedure the lumbar spine is approached from the side through a small skin incision. The surgery is performed through a muscle that lies next to the lumbar spine known as the psoas muscle.

With the XLIF procedure, approximately 2/3 of the disc can be safely removed. After the disc is removed, an artificial graft is placed in between the vertebrae, to allow the bones to fuse together. 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.

What are the advantages of minimally invasive lumbar spinal fusion?The major advantage of all of these minimally invasive techniques is that there is less damage caused to the surrounding tissues. Unfortunately, in traditional spinal surgery it is necessary to cut through muscles and move them out of the way in order to reach the spine. This can cause a large amount of pain following surgery, and it can lengthen the recovery time. Instead of cutting and moving muscles, the minimally invasive techniques can more gently spread through the muscles to allow access to the spine. This is much less painful for the patient, and it does not require as long of a recovery period for the muscle to heal.

Another benefit of less muscle damage is less blood loss and thus a reduced need for blood transfusions using the minimally invasive techniques. There is often less need for narcotic pain medications following this form of surgery, and a shorter hospital stay.