Interbody fusion of the lumbar spine through an anterior, oblique or lateral approach
Fusion of the lumbar (lumbar) spine with an anterior, oblique or lateral approach is a minimally invasive surgical procedure used to treat pain and other symptoms caused by degenerative changes in the lumbar spine, spondylolisthesis, disc herniation, and degenerative deformities of the spine that require correction and is extremely effective in revision surgery of the lumbar spine.
With this surgical procedure, the entire disk of the affected segment is removed and a cage implant filled with bone substitute is implanted in the disk space. With the cage implant, the natural height of the intervertebral space is achieved, and it is possible to very effectively correct the axis of the spine in order to restore the sagittal balance, and the bone substitute helps achieve fusion (long-term ossification) of the segment.
These approaches are performed minimally invasively and at the same time enable a large exposure of the disc space, and thus the possibility of inserting a larger and appropriate cage implant (larger footprint) compared to classic posterior approaches for PLIF and TLIF techniques. In this way, the success rate of the fusion, which is the final goal of the operation, is significantly increased. Additionally, anterior approaches avoid possible complications present in classical posterior approaches, such as the possibility of a dural tear and nerve root lesion.
The surgical procedure is performed using an anterior, oblique, or lateral approach, allowing safe removal of the intervertebral disc, release of neural structures from pressure, and insertion of a cage implant, depending on the patient's indication and the method of performing the surgical procedure. The operation is performed using a minimally invasive technique with the highest chance of success.
Surgeries are designed to create solid bone mass between adjacent vertebrae and eliminate any movement between the bones, providing long-term pain relief and maintaining the spinal axis and the natural height of the former intervertebral disc.
The advantages are: small skin incision, preservation of muscles (muscles are separated), possibility of inserting a suitable implant, less bleeding, lower risk of infection, shorter duration of physical therapy, and faster recovery.
The difference in ALIF, OLIF, and LLIF techniques is the incision site and internal access to the affected spinal segment.
Who are the candidates?
Candidates for interbody fusion surgery of the lumbar spine through an anterior, oblique, or lateral approach are people who have severe pain in the lumbar spine that does not decrease after physical therapy or is successfully controlled with a reasonable amount of analgesics. Candidates are people with a disorder of the sagittal balance of the spine (reduction of physiological lordosis of the lumbar spine), degenerative or isthmic spondylolisthesis, and FBSS syndrome (failed back surgery syndrome) after unsuccessful lumbar spine surgeries.
Interbody fusion of the lumbar spine with an anterior, oblique, or lateral approach is usually very successful in relieving pain and other symptoms, but it is important to talk to a specialist about possible risks and benefits because each patient is individual.
For the above symptoms, the first step in treatment is conservative therapy, such as physical therapy, pain and inflammation medications, exercises to strengthen the muscles of the back and spine, and other methods that can help reduce pain and symptoms. If conservative treatment fails and symptoms worsen, interbody fusion of the lumbar spine can be considered in the technique that best suits the patient with a prior diagnosis by a specialist.
