RANDALL F. DRYER, M.D.
TOP RATED U.S. SPINE SURGEON
Lateral Lumbar Interbody Fusion
Frequently Asked Questions
What are indications I may need LLIF spinal surgery?
When considering the indications for lumbar spine fusion, low back pain that lasts for more than six months is the most general indication. The indications for fusing the vertebrae of the low back occur primarily in situations where there is a large deformity, such as:
- Mechanical back pain (usually attributed to disc degeneration)
- Spinal stenosis (narrowing of the spinal canal)
- Recurrent disc herniation
- Degenerative scoliosis
- Spinal instability (spondylolisthesis)
- Revision of total disc replacement
What diagnostic tools will you use to determine if I need LLIF surgery?
During the initial consultation, we will use some or all of the following to determine whether you require the LLIF procedure:
- Patient history
- Physical Exam
- X-Rays, Magnetic Resonance Image (MRI) or CT Scan
- Myelogram and CT Scan
- Treatment Alternatives
Are there alternatives to surgery?
Possibly, yes. During your consultation and exam, we will also discuss the possibility of non-surgical alternatives. These may include:
- Physical therapy (Exercises and stretching)
- Chiropractic Manipulation
- Epidural Steroid Injections (ESIs)
- TENS Units
What is the purpose of LLIF?
The primary purpose of this procedure is to stabilize the spine by restoring the disc height and fusing the vertebrae together using the patient’s own bone or a genetically engineered substance known as Bone Morphogenetic Protein (BMP).
LLIF fuses the vertebrae of the spine through an approach from the side of the body. The spine is accessed through two 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.
Where does the bone for fusion come from?
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.
What are the advantages of an LLIF approach?
The LLIF procedure has several theoretical advantages over some other approaches to lumbar fusion. These include:
- 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 my spinal procedure?
Surgeon – The orthopedic surgeon that you have been seeing in our office will be the 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.
What should I expect of my 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. He may put you in a back brace to wear for comfort while the fusion is progressing.
How will I need to care for my incision?
Your doctor will tell you when it is safe to shower after surgery. 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. 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.
What are the risks and potential complications of LLIF back surgery?
Any surgery comes with some level of risk and potential complications, though working with a spine specialist for your orthopedic surgery does help minimize those risks. The potential complications of the LLIF procedure may include:
- Complications from anesthesia
- Continued low back pain
- Fusion may not occur (higher incidence of non-fusion in patients who smoke)
- Hardware (i.e. pedicle screws or cages) may break or come loose
- Nerve damage
- Loss of sexual function
How soon will I be able to return to my normal daily routine?
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.
If your primary care physician has said you may need spinal surgery, talk with the experts today. Set up your initial consultation with a spine specialists at Central Texas Spine Institute online or call us today to make an appointment!
No guarantees can be made as to the success of this procedure.
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