SPINAL STABILIZATION SURGERY

March 25, 2021 Nicholas Lancaster

Spinal Stabilization Surgery (Spinal Fusion)

Spinal Fusion is a procedure in which two vertebrae are fused together in order to stabilize the spine. A spinal fusion used to treat a wide variety of conditions, including the following:

· Herniated discs

· Degenerative disc disease (DDD)

· Scoliosis

· Spinal stenosis

· Unstable spine

· Spondylolisthesis

· Swelling of the spinal cord (myelomalacia)

A fusion is most commonly performed in the lumbar (lower back) and cervical (neck) regions of the spine. There are several different types of spinal fusions each with a specific purpose in treating spinal injury.

For the lumbar (lower back):

· PLIF

· TLIF

· XLIF/DLIF/LLIF

· AXIALIF

For the cervical (neck):

· ACDF

PLIF – Posterior Lumbar Interbody Fusion

The PLIF is defined as a posterior lumbar interbody fusion. Posterior meaning backside, this procedure is performed when the surgeon enters the injured area through the backside (posterior) area of the patient and fuses the affected vertebral bodies.

Posterior lumbar interbody fusions are used in treating the following conditions: degenerative disc disease, spondylolisthesis, degenerative scoliosis, and bilateral decompression. The limitations of this procedure are that the surgeon is required to pull back more of the muscular tissue in order to successfully complete the procedure. Thus, this procedure is commonly performed in an inpatient (hospital) setting and commonly requires more significant recovery time.

TLIF – Transforaminal Lumbar Interbody Fusion

The TLIF procedure is defined as a transforaminal lumbar interbody fusion. “Trans” means across, this procedure is performed from a more lateral approach vs. a midline incision. The surgeon’s goal with this approach is to access the injured area of the spine with minimal tissue disruption (damage to the muscles). When performed appropriately, this procedure is effective at minimizing the recovery time for patients after surgery.

The TLIF procedure is commonly used to treat degenerative disc disease, spondylolisthesis (Grade I and Grade II), spinal stenosis, prior fusion surgery with one-sided radiating pain, and instability of the spine. The limitations for TLIF procedures are they typically can only used to be treated one level (two vertebral bodies next to each other) of the spine, the procedure is a very complex procedure that has a steep learning curve for surgeons, and a surgeon has limited visualization of the spine due to the approach to access the vertebral bodies.

There are numerous benefits to a successful TLIF. The most beneficial aspect of the TLIF for patients is that the procedure can be performed through a minimally invasive approach. Minimally invasive meaning that the surgeon can access the injured area of the spine and perform the procedure with minimal muscle ripping or tearing. Because there is minimum muscle ripping and tearing the patient has a much quicker recovery time and the procedure can be performed in an outpatient setting – less risk of infection.

XLIF, DLIF, and LLIF – Xtreme Lateral Interbody Fusion, Direct Lateral Interbody Fusion, Lateral Lumbar Interbody Fusion

XLIF, DLIF, and LLIF are all terms used to describe the minimally invasive lumbar fusion surgery used to treat degenerative disc disease, spondylolisthesis, and degenerative scoliosis. The benefits of these techniques are that there is minimal muscle tearing (surgical trauma), reduce operative bleeding, and reduce hospital stay. Each of these benefits correlates to a quicker recovery time for patients and less chance of infection. However, this procedure does have its limitations. For the XLIF, DLIF, and LLIF procedures they are limited to only the upper lumbar region. The lumbar vertebral region of the spine is made up of 5 vertebral bodies: L1, L2, L3, L4, L5, and one sacral region S1 which is located at the very bottom of the spine (the tailbone). For the XLIF family of procedures, a surgeon is limited to only L1, L2, L3, and L4 regions. The ideal patient for these procedures will have pathology at vertebral levels of L2/L3 and/or L3/L4.

AxiaLIF – Axial Lumbar Interbody Fusion

AxiaLIF stands for Axial Lumbar Interbody Fusion. The AxiaLIF is another form of the lumbar fusion procedure. As with other fusion procedures, the AxiaLIF procedure is designed to stabilize the spine and help to prevent motion that causes pain. The AxiaLIF is commonly used in patients that have Spondylolisthesis or may have had a failed prior surgery at the L5-S1 level (very bottom of the spine). The main advantage of the AxiaLIF procedure is that it can be performed using the minimally invasive approach. A surgeon is able to access the injured area of the spine while minimizing surgical trauma (damage to the surrounding tissues). This results in quicker recovery time for the patient and minimizes the chance of infection. The limitations of the AxiaLIF procedures are they are typically only used on the lower area of the spine. Most of the time and AxiaLIF procedure is performed on the L5-S1 region and in some instances can be used on the L4-L5 region.

ACDF – Anterior Cervical Discectomy Fusion

The ACDF procedure stands for Anterior Cervical Discectomy Fusion. This is the most common fusion procedure performed on the neck (cervical region). The ACDF procedure is when the surgeon takes an anterior (front) approach to the cervical spine (neck). A small horizontal incision is made and the surgeon will perform a discectomy in conjunction with the fusion procedure. During the discectomy, the injured intervertebral disc is removed and bone graft material is inserted along with rods and screws to stabilize the injured level and prevent painful motion. The ACDF procedure is used to treat cervical radiculopathy (pain that radiates into the arms), spinal and foraminal stenosis (narrowing of the spinal canal where the nerve root exits), myelomalacia (softening of the spinal cord), and degenerative disc disease. Some limitations of the ACDF procedure include post-surgical complications with adding more stress on the levels above and below the procedure site – since the fused level is fixed, as the neck moves more stress is being placed on the level above the fused site and the level above the fused site. Thus, oftentimes an ACDF can result in an increased chance of injury to the level above and below the fusion. Additionally, the ACDF can increase the risk of damage to the laryngeal tissue (throat structures) – because the surgeon must enter through the front of the neck there is a risk of damage to the tissue as the surgeon is accessing the injured level.

In summary, the above procedures are those that are commonly used in fusion surgeries for both the lumbar (lower back region) and cervical (neck region) of the spine. All fusion surgeries aim to limit motion at the injured level by fusing the vertebral levels together. While fusion technology and fusion surgeries have come a long way, they should only be considered after all conservative treatment options have been exhausted or if an emergent medical condition exists.

At AOMSI diagnostics, we provide the most accurate spinal imaging available in the healthcare marketplace. This imaging has been proven in peer-reviewed medical journals to be the most accurate, reliable, and specific spinal imaging when compared to traditional spinal imaging modalities. Often times we are able to expedite pre-authorizations for surgery or even overturn denials for spinal surgery after the VMA study is presented to insurance.