Minimally invasive fusion techniques are used to accomplish the same goals as open fusion surgery but with much smaller incisions, less tissue disruption, faster recovery, shorter hospital stays, less blood loss and less postoperative pain. There are several minimally invasive fusion techniques used at The Spine Center. Several are described below.
Minimally Invasive Fusions
iFuse Implant System
The iFuse Implant System is a minimally invasive option for patients suffering from sacroiliac joint disorders, including SI joint disruptions and degenerative sacroiliitis.
The iFuse procedure takes about an hour and involves three small titanium implants inserted surgically across the sacroiliac joint. The entire procedure is done through a small incision, with no soft tissue stripping and minimal tendon irritation. Patients may leave the hospital the next day after surgery and can usually resume daily living activities within six weeks, depending on how well they are healing and based on physician’s orders.
The iFuse procedure offers several benefits compared to traditional sacroiliac joint surgery:
- Minimal incision size
- Immediate post-operative stabilization
- Minimal soft tissue stripping
- Potential of a quicker recovery
Lateral Lumbar Fusion
This surgical technique is done with the patient positioned on their side. Through a small incision (2cm) special dilators are used to dilate down to the side of the vertebrae. Special nerve monitoring is used to navigate these away from the small nerves that are bundled in this area over the spine. Once in a safe position, a retractor is inserted and the dilators are removed. Through this retractor, microscopic magnification is used to visualize the disc which is then removed. In place of the disc a special artificial spacer is placed with bone graft incorporated in its center. This allows distraction of the disc space that was previously collapsed and as a result indirectly opens the areas where the nerves were once compressed. In addition, this spacer provides structural support, corrects any scoliosis and allows fusion to occur in this area. Using this minimally invasive technique avoids any incision or disruption of the sensitive muscles of the lower back.
Once the spacer has been inserted, the wound is closed and dressed and the patient is brought to the recovery area. Patients typically stay in the hospital one to two days. The video link below is a brief movie demonstrating the procedure.
The Axial LIF procedure is a newly developed minimally invasive fusion technique that allows fusion of the lowest or the lower two levels of the low back through a tiny incision. This incision is placed at the base of the buttock far below the waist line. This is cosmetically advantageous and also allows us to avoid any incision on the sensitive muscles of the lower back.
Through a small 1 cm incision made at the base of the buttock, the space in front of the tailbone is entered. This region allows safer access to the front of the sacrum. A small hole is created in the sacrum that allows access to the disc space. Using special instruments and image guidance, work is done through this small hole to remove the disc and fuse the interbody area. Bone that was obtained from the small hole is used as the graft to allow the fusion. In addition, a special screw rod device is inserted to secure this area and distract the previously collapsed disc space. This indirectly opens the space where the nerves are exiting the spinal canal and as a result alleviates the pressure and pain created by this.
Once this is complete the small incision closed and the patient is brought to recovery. Typically patients are discharged the next day. Click here to see a short video about Axial LIF procedure.
Percutaneous fusion is a procedure that is accomplished through several small pokes in the skin. A 360° fusion can be obtained using special techniques and without the required incision and pain typical of an open fusion surgery.
Through the small pokes in the skin the disc is entered and removed using special instruments and nerve monitoring. Once the disc is cleared out, a special graft containment device is inserted into the space through a small canula. This device is then packed slowly with bone through this canula. As it is packed the device and disc space expands until it completely fills the disc space. This allows an interbody fusion. Screws and additional bone graft are placed through additional small pokes in the skin. This allows stabilization and fusion over time.
Patients typically are discharged the following day. As a result of the minimally invasive nature of this procedure; significant blood loss, postoperative pain, and hospital stays are all avoided.
Minimally Invasive TLIF
Transforaminal Lumbar Interbody Fusion (TLIF) is a surgery that has been used to decompress and fuse the lower back for many years. This surgery is still used commonly today and typically performed through an open approach. A minimally invasive TLIF accomplishes the same goals through a tiny incision. Special dilators and tubular retractors are used in combination with microscopic magnification to perform this surgery through the small incision.
Through these small tubular retractors, the lumbar spine can be decompressed. During this process, bone spurs and disc material that is pressing on nerves and causing symptoms can be removed with special instruments. An implant is then placed where the disc once was to allow structural support and fusion. Screws are then placed through small poke incisions in the skin. This stabilizes the spine and supports the construct until the fusion can heal completely.
Typically patients are discharged 1 to 3 days after the surgery. As compared with open surgery, significant blood loss, postoperative pain, and hospital stay can be avoided through these minimally invasive techniques.