Minimally Invasive Lumbar Fusion

What is a minimally invasive lumbar fusion?

When spinal arthritis has progressed to the point of spinal instability (spondylolisthesis, scoliosis, recurrent disk herniation, or severe degenerative disc disease), the patient may require a combination of a lumbar decompression (laminectomy) and lumbar fusion to stabilize the spine to alleviate back and leg pain.

A lumbar fusion can be performed using the traditional open technique or with minimally invasive methods. In traditional open spinal fusion surgery, the surgeon must make a large incision in the middle of the back and cut through thick spinal muscles requiring a prolonged hospitalization and rehabilitation.

In minimally invasive surgery, Dr. Singh can utilize special instrumentation that allows for a much smaller incision (less than the size of a quarter) without cutting muscles. In addition, Dr. Singh performs these minimally invasive lumbar fusions as an outpatient procedure without the need to stay in the hospital. Dr. Singh, avoids cutting the muscle and the stabilizing structures in the back, allowing those patients who undergo minimally invasive fusion to return back to high levels of activity including professional sports such as basketball and baseball.

When is a minimally invasive lumbar fusion performed?

Dr. Singh at Midwest Orthopaedics at RUSH Minimally Invasive Spine Institute may recommend a spinal fusion to alleviate symptoms for many back conditions, including:

• Recurrent disc herniation
• Spinal stenosis
• Spondylolisthesis
• Fracture
• Scoliosis
• Degenerative Disc Disease

Who is a candidate for minimally invasive lumbar fusion?

Dr. Singh will thoroughly evaluate your past treatment, your current imaging (MRI/CT) and perform a complete examination to determine if you are a candidate. In general, patients with conditions for which a minimally invasive lumbar fusion may be recommended include:

• No improvement with non-surgical treatment with unrelenting back and leg pain
• Spondylolisthesis (slippage of the vertebrae)
• Recurrent disc herniation
• Scoliosis
• Severe degenerative disc disease

How is a minimally invasive lumbar fusion performed?

A minimally invasive lumbar fusion can be performed from the front (anterior approach), from the back (posterior approach) or from the side (lateral approach). Dr. Singh will choose the least invasive approach for each patient based upon many factors, including the need for bone spur removal, the degree of instability, the medical condition, and the physical characteristics of the patient. Usually, the decision as to which approach makes the most sense involves a discussion of the pros and cons of each approach in a particular situation. The following are spinal fusion approaches that may be considered:

• Anterior Lumbar Interbody Fusion (ALIF) with Instrumentation (front the front)
• Transformational Lumbar Interbody Fusion (TLIF) (from the back)
• Lateral Interbody Fusion (XLIF, DLIF, OLIF) (from the side)

Anterior Lumbar Interbody Fusion (ALIF) with Instrumentation

In ALIF, the procedure is performed from the front allowing Dr. Singh to access the spine without moving any nerves and disturbing the back muscles. In this procedure an incision is made like a much smaller C-section type approach. Dr. Singh does this surgery with a highly skilled general surgeon who helps with the approach.

Transforaminal Lumbar Interbody Fusion (TLIF)

In TLIF, Dr. Singh uses the posterior (back) approach through two or three small incisions the size of your fingertip.  This approach requires no movement of the nerves and opening of back muscles unlike a traditional surgical approach.

Lateral Interbody Fusion (XLIF/DLIF/OLIF)

These lateral procedures make use of the side (lateral) approach avoiding the spinal muscles. This lateral approach involves an incision about the size of your fingertip right at the level of your waist on your side.

Schedule a Consultation

Chicago spine surgeon Dr. Kern Singh can assess your situation, provide an accurate diagnosis and guide you on the most suitable minimally invasive fusion.

Dr. Kern Singh, MD is an internationally renowned spine surgeon specializing in outpatient minimally invasive and motion-preserving techniques and endoscopic spine surgery at Midwest Orthopedics at RUSH and Professor in the Department of Orthopedic Surgery at RUSH University Medical Center in Chicago, Illinois. Dr. Kern Singh is one of the nation’s Top 100 spine surgeons and beloved by his patients for his compassionate care and excellent outcomes. He welcomes nationally and internationally based patients.

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References

• Kim H, Chang BS, Chang SY. Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review. Neurospine. 2022 Mar;19(1):163-176. doi: 10.14245/ns.2143236.618. Epub 2022 Mar 31. PMID: 35378589; PMCID: PMC8987540.
• https://orthoinfo.aaos.org/en/treatment/minimally-invasive-spine-surgery/