6818 Austin Center Blvd #200

 Diagnostic Tools

            Patient history  

Physical Exam

X-Rays, Magnetic Resonance Image (MRI) or CT Scan

Discogram

EMGs

Myelogram and CT Scan

Treatment Alternatives

          Medications

            Physical therapy (Exercises and stretching)

            Chiropractic Manipulation

            Epidural Steroid Injections (ESIs)

            TENS Units

 Purpose of Procedure

The primary purpose of this procedure is to stabilize the spine by restoring the disc height and fusing the vertebra together using the patient's own bone or a genetically engineered substance known as Bone Morphogenetic Protein (BMP).  XLIF fuses the vertebra of the spine through an approach from the side of the body.  The spine is accessed thru 2 small incisions – one directly over the side of your waist and the other incision slightly behind the first, toward your back muscles.  This approach is made safe with the use of nerve monitoring technology that alerts the surgeon if he comes near or hits a nerve. 

Bone for Fusion

There are currently two primary alternative sources for the bone needed for the spinal fusion.  Traditionally, some of the patient's own bone has been harvested from the iliac crest (hip bone).  This technique produces excellent results for the fusion.

Earlier in 2003, the FDA approved a genetically engineered bone substitute for use in lumbar spinal fusions.  Under the brand name, InFUSE, BMP converts stem cells into bone forming cells and stimulates rapid growth of bone at the targeted site. 

Using BMP eliminates the need for harvesting the patient's own bone and speeds up the fusion process. 

Advantage of XLIF Approach

The XLIF procedure has several theoretical advantages over some other approaches to lumbar fusion: 

·        Reduced operative time, and thus, reduced time under anesthesia

·        Reduced blood loss and minimal scarring

·        Reduced post operative pain because the approach does not disrupt

          sensitive back muscles, bones and ligaments

·        Reduced hospital stay – patients usually up and walking the same day

·        Typical recovery is usually about 6 weeks   

Who will be involved in procedure?

Surgeon - The orthopedic surgeon that you have been seeing in our office will be your primary surgeon, in charge of your surgery.

Assistant Surgeon - Another orthopedic surgeon, usually from our office, will assist your orthopedic surgeon with the procedure.  This is done to minimize the length of time you are under general anesthesia and to provide the necessary assistance with the actual surgical procedure.

Anesthesiologist  - The doctor who actually administers and monitors the anesthesia is a critical part of the surgical team.  You will normally meet with the Anesthesiologist during your Pre Op appointment at the hospital.

Neuro Monitor – Because of the surgical approach, nerve monitoring is used to alert the surgeon if he is close to or touching a vital nerve during the procedure.           

Hospital Stay

With most spinal surgeries, patients are up and walking within hours after their procedure, although the walking is very limited.  It is no longer necessary, or recommended, that you lie in bed for days or weeks after spine surgery.  Nurses who are experienced in working with spinal surgery patients will assist you during your first few efforts at getting out of bed and walking.  Your doctor will tell you when it is safe to shower after surgery.   He may put you into a back brace to wear for comfort while the fusion is progressing.  

Incision Care

The nursing staff at the hospital will show you how to keep the dressing dry and in place to protect the incision while showering.  The wound should not be submerged in water (pool or tub) until it has healed and has been cleared by your doctor. The nurse will change the dressing after your shower, and again later if necessary.   

Your surgical incision will be checked during your first Post Op appointment.  However, should your incision become red and tender or drainage occurs, prior to your first scheduled Post Op visit, you should contact our office for instructions.   

Risks and Potential Complications

           Infection

Bleeding

Complications from Anesthesia

            Continued Low Back Pain

Fusion May Not Occur (higher incidence of non-fusion in patients who smoke)

Hardware (ie. pedicle screws or cages) may break or come loose

            Numbness

Nerve Damage

            Weakness

            Loss of Sexual Function

            Infertility

            Death 

Return to Routine of Normal Daily Living

It normally takes approximately 3 to 6 months for the fusion to occur.  During that time you should avoid strenuous activities that might affect the fusion process.  During the rehabilitation process it is important to recondition the muscles with exercise, stretching and aerobic conditioning.  

No Guarantees

            No guarantees can be made as to the success of this procedure. 

Other Educational Resources

            www.lateralaccess.org/patient/xlif_procedure

           www.spine-health.com

            www.spineuniverse.com        

            www.spine-surgery.com

Double click to download a printed version of XLIF FAQs