Lateral Lumbar Interbody Fusion
Lateral Lumbar Interbody Fusion has evolved as a predominant surgical technique for discogenic back pain. The advantages of this technique is that it is a minimally invasive muscle sparing technique, which minimises the surgical footprint. Furthermore the restoration of disc height indirectly decompresses nerves and improves standing balance.
This minimally invasive technique is also know as direct lateral interbody fusion (DLIF) or extreme lateral interbody fusion (XLIF).
This technique can be used to access discspaces from T12/L1 to L4/5 for a variety of pathologies. Is offers the benefit of indirect decompression of nerves and is particularly useful in revision spine surgery for adjacent segment pathology.
The diagnosis is made with history, physical examination and corroborated with focused X-ray and MRI examination.
Non -Operative Treatment
This involves rest, activity modification , pain-killers, physical therapy and occasionally corticosteroid and local anaesthetic injections.
The discspace can be approached through a number of corridors. Dr Nair utilises the transpsoas approach. This approach has the avantage of having a direct trajectory to the disc space, avoiding important vascular structures and sparing the stabilising posterior spinal musculature. The diseased disc is then excised and an implant (interbody cage with bone substitute) is inserted under x-ray control. It is then secured in place. In certain instances, the device may require addition supplementation with posterior screws and this will be discussed in the pre-operative consultation.
Risks include disruption of nerve function ( this is mitigated by use of intraoperative electrophysiological monitoring -circuit testing ) as well as meticulous technique. The vast majority of symptoms due to nerve dysfunction resolve after 6 months. Late risks include implant subsidence and adjacent segment pathology
Post Operative Instructions