Lumbar Interbody Fusion

SPINAL FUSION SURGERIES

  • Spinal fusion = procedure in which two or more vertebrae are fused together / fusion surgery
  • typically requires a bone graft (autograft from pelvic bone or allograft from donor)
    • bone is packed between vertebrae to “fuse” them together (posteriorly or between vertebral bodies)
  • GOAL: stimulate vertebrae to grow together into one solid bone (a fusion) and create a rigid, immovable column of bone
  • when done between vertebral bodies, bone graft + biomechanical spacer implant replaces IV disc which is removed
  • INDICATIONS:
    • spondylolisthesis
    • scoliosis
    • severe disc degeneration
    • spinal fractures
  • Common Fusion surgeries
    • PLIF, ALIF, TLIF XLIF

ALIF XLIF PLIF TLIF

POSTERIOR LUMBAR INTERBODY FUSION (PLIF) 

  • involves posterior incision
  • Technique: video
    • 3-6 inch incision posteriorly, spinal muscles retracted
    • laminectomy to access nerve roots
    • facet joints may be trimmed to allow more room
    • discectomy – affected disc removed
    • implants inserted
      • bone graft, allograft
      • fusion cage – bone graft from pelvic rim packed in a special case
    • rods or screws for further stabilization
      • pedicle screws inserted to fix bone in place (holds the vertebrae together, prevents motion, improves bone healing / fusion)
      • posterolateral bone grafting – may add bone graft along posterior spine to fuse larger area on the back

fusion cage

plbg

TRANSFORAMINAL LUMBAR INTERBODY FUSION (TLIF)

  • refinement of PLIF (video)
    • same approach as PLIF but more lateral
  • Advantages:
    • reduces amount of surgical muscle dissection
    • minimizes nerve manipulation to access vertebrae, discs and nerves
    • less traumatic to spine, safer for nerves, allows for minimal access and endoscopic techniques for spinal fusion

ANTERIOR LUMBAR INTERBODY FUSION (ALIF)

  • Technique: video
    • anterior approach
    • incision in lower abdomen or side
    • may involve incision and repair of lower abdominal musculature
    • abdominal muscles and blood vessels retracted
    • disc material removed
    • bone graft (cages, rods, screws) inserted

EXTREME LATERAL INTERBODY FUSION (XLIF)

  • minimally invasive approach to anterior spine
  • avoids transverse abdominal incision
  • Technique: video
    • disk space accessed from flank incision
    • fluoroscopy-guided
    • disk material removed from spine and replaced with bone graft, and cage (bone, titanium, carbon-fiber, or polymer)
  • Advantages:
    • shorter hospital stay
    • may be less painful
  • Limitations:
    • only vertebra with clear lateral access can be approached using this technique
    • only one or two levels can usually be accessed

xlif

another Animation of XLIF procedure

References

Cnsa.com,. ‘Neurosurgery Notes – Fall 2010 – Direct Lateral Spinal Fusions: A New Minimally Invasive Approach, XLIF Surgery’. N.p., 2015. Web. 11 Oct. 2015.

Eorthopod.com,. ‘Posterior Lumbar Interbody Fusion | Eorthopod.Com’. N.p., 2015. Web. 11 Oct. 2015.

Sandiego-spine.com,. ‘PLIF, ALIF, TLIF And XLIF: Alphabet Soup Or Surgical Treatments For The Spine?’. N.p., 2015. Web. 11 Oct. 2015.

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