A woman we’ll call Jane recently visited Nkrumah Neurosurgery & Spine with severe back pain. Her symptoms included chronic pain in the lower back, pain and weakness in the legs, and paresthesia (often described as “pins and needles”).
There were a number of challenges that made this patient’s situation unique. First, Jane was older. She presented multiple comorbidities, including diabetes, high blood pressure, and chronic kidney disease. And several years prior to meeting Dr. Nkrumah, this patient had undergone a posterior lumbar laminectomy to achieve decompression of the lumbar spine. Although this procedure did provide some relief for Jane, just a few months after the operation, her symptoms returned, only much worse.
Meeting with Dr. Nkrumah
The first time Jane met with Dr. Nkrumah, she could barely walk. Dr. Nkrumah listened intently as she described her symptoms and previous procedure, along with other health issues she was dealing with that could complicate treatment. With her age and medical history in mind, Dr. Nkrumah began planning a course of treatment.
Together, they looked at her MRIs, which revealed worsening degeneration of the spine. Imaging also showed spinal instability, several collapsed vertebrae, and subtle spondylolisthesis (slipping of the lumbar spine vertebrae), causing bones to rub against each other and press on nerves. Two levels of the spine (the spaces between L3, L4, and L5) were causing the majority of symptoms.
Dr. Nkrumah wanted the procedure to be as easy and painless as possible, especially because the patient’s diabetes might lengthen healing time. The previous procedure left behind a significant amount of scar tissue, which would complicate a traditional posterior surgery (approaching the spine from the back). Cutting through scar tissue can be both difficult for the surgeon and unnecessarily painful for the patient. Alternatively, an anterior procedure (approaching the spine from the front) could pose additional risks to major blood vessels and arteries.
Based on these details, Dr. Nkrumah and the patient decided to proceed with lateral lumbar interbody fusion.
Developing a Treatment Plan
With clear causes for her pain identified, Dr. Nkrumah and the patient began discussing treatment options, both surgical and non-surgical. Based on Jane’s age, condition, symptoms, goals, and preferences, they determined that a minimally invasive spinal surgery could help her achieve maximum relief.
The Procedure
For this patient, Dr. Nkrumah used lateral lumbar interbody fusion to create indirect decompression of the nerves currently compressed by the collapsed vertebrae, restore the height of the spine, and stabilize the spine with the fusion process.
During the operation, Dr. Nkrumah made a very small incision (less than 3cm) between the patient’s ribs and hip bone, avoiding the site of the previous procedure entirely. He then used a retractor to separate the muscles and tissue from the spine without causing damage.
From the side, Dr. Nkrumah used 3D printed titanium grafts (also called interbody cages) to expand the space between each vertebra. This decompressed the spine, freeing the pinched nerves. Finally, he inserted screws to hold the grafts in place. When he removed the retractor, the muscles and tissue returned to their natural positions. The entire procedure took less than two hours.
Recovery and Relief
Many patients who receive lateral lumbar interbody fusion treatment return home the same day; however, considering Jane’s comorbidities, Dr. Nkrumah advised she stay for two. In stark contrast to her significant difficulties walking prior to the procedure, Jane was up and walking the following day with minimal assistance. It would take a couple of weeks to heal, with full recovery expected in just three to six weeks.
Dr. Nkrumah will continue to see a patient like Jane over the course of a year to monitor symptom improvement, taking x-rays as needed. Over time, the patient will gradually introduce high-impact activities back into their lifestyle based on Dr. Nkrumah’s recommendations.
Both Dr. Nkrumah and Jane were extremely pleased with the results of this procedure, and they expect her to return to her daily routine, fully functional and relatively pain-free.
Is an Lateral Lumbar Interbody Fusion Right for Me?
Every patient and situation is unique. If you’re experiencing chronic back pain or other symptoms interfering with your daily life, the team at Nkrumah Neurosurgery & Spine can help. Dr. Nkrumah will spend time learning about your condition, symptoms, lifestyle, and preferences. Together, we can develop a minimally invasive treatment plan to help you achieve maximum relief.
To schedule a consultation, contact our office at (631) 525-1420 or complete this simple online form.
* XLIF is a registered trademark of NuVasive, Inc., San Diego, CA
Sources:
https://www.wjgnet.com/2307-8960/full/v3/i1/1.htm
https://www.spine-health.com/treatment/spinal-fusion/xlif-lumbar-spinal-fusion
https://www.barrowneuro.org/treatment/xlif-surgery/
Lateral Lumbar Interbody Fusion
Lateral lumbar interbody fusion, or extreme lateral interbody fusion (XLIF®), is a minimally invasive surgical procedure for decompression of the lumbar spine, where the surgeon approaches the spine from the patient’s side/flank.
Surgeons may use lateral lumbar interbody fusion to relieve conditions such as:
- Long-term back and/or leg pain
- Lumbar degenerative disc disease
- Degenerative scoliosis
- Recurrent herniated disc
- Spinal stenosis
- Spondylolisthesis
Compared to a traditional posterior operation, a patient undergoing lateral lumbar interbody fusion will experience significantly less blood loss (typically 20cc compared to 200cc when operating from the back), less tissue trauma, and a shorter recovery time. It also doesn’t interfere with major back muscles, bones, or ligaments.
A titanium graft, also called an interbody cage, is used to restore proper separation between the vertebrae, relieving pressure on the spinal nerves.
