XLIF and lateral approach fusions

[Katie]

Hello everyone. I was surfing past threads and came across this one and thought I would add what I could to it, considering a lot of the questions raised here were applicable to me and my surgery with Dr. Luiz Pimenta.

It is quite ironic that I had even posted on this thread, but did not remember anything about it when it came time to dealing with Dr. Pimenta for my surgery. By then, I had literally reached the end of my rope, as I had just found out that I was allergic to all of the appliances available to me back then. Dr. Pimenta was the only one who was able to offer non-metal devices for both my cervical and lumbar levels and was willing to do it.

My husband is very technically minded and when we were given the exact information about the XLIF for my L4/5 and the Nuvasive NeoDisc for my C5/6 when we arrived in Brazil, he was extremely impressed. He studied the approach extensively through the textbook loaned to us by Dr. P before the surgery, plus had the information needed when permission was needed to do an ALIF for my L5/S1 after surgery was already started.

It is correct...the experience of the surgeon is the most important aspect of the surgery, and we had complete faith in his abilities. We had studied his experiences and spoken to as many patients as possible, albeit limited at the time. It mainly seemed to be because of the distance involved, with most of his work being done in South and Central America.

I did have a burning in both of my legs after the surgery, from the groin area down to my ankles, but especially in my right front thigh area. Dr. Pimenta said it was nerve pain from surgery, as I had three big procedures all under one general anesthetic. Plus numerous patients here on the forum reassured me that it was most likely distraction pain from the nerves and ligaments being stretched. That made sense as I 'grew' an inch and a half with that surgery

Regardless, it disappeared within a couple of weeks, and was only really bad on the night following our very long flight home from Sao Paulo.

Overall, I'd have to say that my pain levels have been less than many others who have generally posted on this website from various surgeries, at least from my observations. There was never a point where the pain was overwhelming, and I was able to walk around the following day without the aid of a walker or wheelchair. My husband's arm was enough support, and I was not even needing that after a day or two.

Of all the incision points, the XLIF definitely was the least invasive and least painful. Of the three, I barely noticed that one during the whole healing process. From a patient point of view, I would highly recommend this procedure, and I can honestly compare it to the ALIF and the ADR as I had them all at the same time.

I will go for now, but will happily answer any other questions from others who are curious about this procedure.

[Beth]

I, too, would love a document which explains all the different types of approaches and fusions.

I had a corpectomy with the flank/lateral approach, with rib harvest. My scar is 10" long through the left side.
I've had major problems with my bowels, and the drainage tube has to be left in 3-4 days. That was very painful.
Two weeks after the corpectomy surgery I had a posterior fusion. This scar is up and down and about 5 inches long.
I really had much less pain from the posterior fusion than I had from the flank approach corpectomy.
Of course, now, there's some pain/stability issues that leads my surgeon to believe that I have not fused.

Has anyone else had a non fusion issue? If so, what was done about it? What was the symptoms?

One more question.. has anyone had the stimulator for pain?

[Carmen]

For some reason XLIF and lateral approach fusions rarely get discussed but I think more patients should seriously consider consulting w/an XLIF surgeon pre-op to see if they are a candidate; XLIF cannot be applied to L5-S1. If surgeons are not trained in the lateral approach they will likely not mention it as a treatment option for you.

Here's a link to the Society of Lateral Access Surgeons website, The Society of Lateral Access Surgery
where you can search for a surgeon in your area (i believe it's only working for the US right now) and you can learn more about the procedure.

The few patients that i've heard of that have XLIF fusions are doing quite well... there are two types, one which just uses a plastic spacer w/BMP which is promoted as gentler on adjacent segments (the cage fighter Nate Quarry has helped promote it); the other just uses XLIF as an approach but uses cage, screws, BMP, maybe a plate, maybe posterior rods. The latter approach is currently used by a few surgeons for revision ADR operations and I think it will be adopted by many more in the future to avoid the risks of a repeat anterior operation at L3-4 and L4-5 with the great vessels on top (mainly hemorrhage, possibly death).

In addition to XLIF (Nuvasive's product) there are surgeons that are using the lateral approach for fusions with hardware from other device companies b/c it avoids the vascular risks associated with anterior operations. I saw a neurosurgeon recently whom is going to start performing lateral fusions at L3-4 and L4-5.

This approach still has its risks as it requires going through the psoas muscle (mainly nerve damage), but to me the approach sounds very promising and much less invasive than anterior or posterior. It also avoids cutting the anterior longitudinal ligament which can sometimes result in instability.

good luck!
Liz

Hi Liz,
Thank you for a great report on the XLIF. I think if a doctor has a myelogram to guide him during surgery, nerve damage may be lessened. The doctors' that I received opinions from all were performing the XLIF using the minimally invasive approach. I guess on the forum I just assumed the member's doctor's were providing that particular surgery option. Thanks again. Carmen

[Carmen]

For some reason XLIF and lateral approach fusions rarely get discussed but I think more patients should seriously consider consulting w/an XLIF surgeon pre-op to see if they are a candidate; XLIF cannot be applied to L5-S1. If surgeons are not trained in the lateral approach they will likely not mention it as a treatment option for you.

Here's a link to the Society of Lateral Access Surgeons website, The Society of Lateral Access Surgery
where you can search for a surgeon in your area (i believe it's only working for the US right now) and you can learn more about the procedure.

The few patients that i've heard of that have XLIF fusions are doing quite well... there are two types, one which just uses a plastic spacer w/BMP which is promoted as gentler on adjacent segments (the cage fighter Nate Quarry has helped promote it); the other just uses XLIF as an approach but uses cage, screws, BMP, maybe a plate, maybe posterior rods. The latter approach is currently used by a few surgeons for revision ADR operations and I think it will be adopted by many more in the future to avoid the risks of a repeat anterior operation at L3-4 and L4-5 with the great vessels on top (mainly hemorrhage, possibly death).

In addition to XLIF (Nuvasive's product) there are surgeons that are using the lateral approach for fusions with hardware from other device companies b/c it avoids the vascular risks associated with anterior operations. I saw a neurosurgeon recently whom is going to start performing lateral fusions at L3-4 and L4-5.

This approach still has its risks as it requires going through the psoas muscle (mainly nerve damage), but to me the approach sounds very promising and much less invasive than anterior or posterior. It also avoids cutting the anterior longitudinal ligament which can sometimes result in instability.

good luck!
Liz

Dear Liz,
I am posting what the mylogram had to say for the most part. Hopefully the above surgical procedure will do the trick.

Performed April 7, 2010

. Multilevel degenerative change

. Complete obliteration of the L5 to S1 disk

. L4 and L5 there is a pronounced rotatory subluxation component

. Rotoscoliosis of the lumber spine with marked multilevel degenerate change

. Central canal is most compromised at L2 to L3 due to disk herniation

. Multiple levels of lateralizing degenerative change resulting in neural foraminal narrowing.

Carmen