Artificial disk replacement (ADR)
ADR is placed through an exposure similar to the ALIF. Instead of putting in a graft for fusion, an artificial disk is implanted. The two currently FDA approved ADRs are Charite and ProDisc. Both of these artificial disks have the potential to maintain motion at the implanted segment.
Watch video of the lumbar ProDisc procedure |
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Microdiskectomy
Lumbar discetomy is one of the most common spine procedures performed today. After a small incision over the lumbar segment that has the herniation, a small opening is made in the bone of the spine (called a laminotomy). The spinal sac and nerve are visualized, gently retracted, then the disk herniation is located and removed.
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Laminotomy/foraminotomy
Bone spurs (ie spinal stenosis) can be removed by doing a laminotomy and foraminotomy. This involves resection of the medial lamina and the facet joint.
 See our glossary of terms
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Laminectomy
Laminectomy is a commonly performed procedure to treat spinal stenosis. The procedure involves resection of the spinous process, lamina, and mesial (most midline portion) facet joints. In addition, foraminotomy is also performed. If required, a diskectomy can be simultaneously done to treat a disk herniation. Laminectomy can also be done when spine tumors need to be removed. Although an excellent procedure to treatment of certain disorders, Laminectomy does carry the risk of facet injury and spinal instability.
See our glossary of terms |
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TLIF -Trans-Foraminal Interbody Fusion
PLIF -Posterior Lumbar Interbody Fusion
Trans-Foraminal Interbody Fusion (TLIF) or Posterior Lumbar Interbody Fusion (PLIF) are both posterior methods to do a lumbar fusion. Both procedures require a laminotomy (or laminectomy), diskectomy with subsequent insertion of an allograft (either cadaver or PEEK) and/or autograft (bone from the patient’s own body) into the disk space. Over time, the 2 lumbar segments fuse and become one segment. Instrumentation (usually titanium pedicle screws) is often inserted to help stabilize the segment while the fusion heals. |
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XLIF-Extreme Lateral Interbody Fusion
XLIF (eXtreme Lateral Interbody Fusion) is another way to do a lumbar fusion. Instead of inserting a PEEK allograft via a posterior approach (like in TLIF or PLIF), the allograft is implanted laterally (through the right or left side of the disk space). This procedure can only be performed at L4/5 or higher levels and requires dissection through the psoas muscle. After the diskectomy and placement of the XLIF graft, instrumentation is then usually put in (either via a lateral titanium plate or posterior pedicle screws).
Watch video animation of XLIR procedure |
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ALIF -Anterior lumbar Interbody Fusion (ALIF)
As opposed to TLIF and XLIF, ALIF fusions are done from the front (anterior through an abdominal incision). After making an incision at or below the belly button, the abdominal contents (intestine, ureters, iliac arteries and veins) are moved to the side and the disk space removed. Then, an allograft or autograft are inserted. Often a titanium plate and screws are then put in or posterior pedicle screws are inserted through another incision (a 360 degree fusion).
See our glossary of terms |
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X-STOP
X-STOP is a lumbar spinous process distraction device that is used to treat lumbar spinal stenosis. The device is an “indirect” decompression device that relies on distraction between the lumbar vertebra in order to open the spinal canal and hence decompress the spinal nerves. In one well designed study, the device has been compared against and been shown to be more effective than conservative care (therapy, medications, and epidural steroid injections). However, X-STOP has not been directly compared with microdecompression surgery. In addition, X-STOP is indicated in patients with mild to moderate stenosis symptoms whereas microdecompression surgery is better for patients with severe symptoms). Please see the animation for an illustration of the procedures.
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Kyphoplasty
Kyphoplasty is a procedure used to treat painful fractures of the lumbar and thoracic spine. Typically, compression fractures are due to osteoporosis, but tumor induced fractures can also be treated using this procedure. The procedure is usually done as an outpatient and involves injection of PMMA cement into the fractured vertebral body. Vertebroplasty is a competing technology that also is used to treat similar fractures. However, many published studies have shown a lower rate (and hence safer profile) of cement leakage out of the injected vertebra. Watch the Kyphoplasty video.
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Lumbar Fusion
Lumbar fusion means fusing across the disk space and facet joints of the lumbar (or thoracic) vertebra. Fusion across the disk space is accomplished by either a TLIF, XLIF, or PLIF approach. Then, instrumentation (titanium rods and pedicle screws) is inserted in order to stabilize the spine while the fusion heals over 2-3 months. Often the hardware can be inserted through a minimally invasive percutaneous approach as described in the attached animation of the Longitude pedicle screw system.” Watch the lumbar fusion video. |
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