The Anand Spine Group - Spine Specialists Los Angeles

Leaders in Minimally Invasive Spine Surgery

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Back and Leg Pain

Patients with back and/or leg pain should be evaluated for issues with the back (thoracic or lumbar spine).  The thoracic spine is made up of 12 vertebrae and the lumbar spine is made up of 5 vertebrae.  The spinal cord runs through the middle of the thoracic spine and ends around T12-L1.  The spinal canal extends down to the sacrum and houses individual nerve roots.  These individual nerve roots exit the spinal canal at each lumbar level.  Compression of either the spinal cord/canal or the nerve roots can result in back pain, leg pain, tingling, numbness, and/or weakness.  This often occurs due to a disc herniation, stenosis (thickened ligament), or instability of the spine such as with spondylolisthesis, scoliosis, or kyphosis.  Severe compression of the spinal cord in the thoracic spine can result in leg weakness and/or loss of balance.

Evaluation of back/leg pain includes a clinical exam, lumbar x-rays, MRI scan, and possibly a CT scan and/or standing scoliosis x-rays.

Surgical treatments for back/leg pain are determined on an individual basis.

Treatment options include:

Microdecompression/Microdiscectomy

A microdecompression or microdiscectomy stands for a spinal decompression from a posterior approach with the use of a microscope.  The goal of a microdecompression/microdiscectomy is to remove any material compressing the spinal canal or nerve roots with the least disruption to the tissues and least risk of spinal instability.  It is usually indicated for patients with intractable back and leg pain with stenosis and/or disc herniation.

The surgeon shaves the edges of the bone to gain access to the spinal canal and nerves.  He then decompresses the spinal canal and nerves by removing thick ligament, bone and/or disc material that is compressing the nerves. 

Lumbar Artificial Disc Replacement (ADR)

Lumbar ADR stands for artificial disc replacement in the lumbar spine. It is a motion preservation technique that allows for decompression of the spinal canal and nerve roots and maintains the natural movement of the back. It is usually indicated for patients with intractable back and leg pain with disc degeneration, stenosis or a disc herniation.

The surgeon accesses the spine from an anterior approach through the abdomen and uses a series of tools to remove the disc between the two vertebral bodies.  He then carefully decompresses the spinal canal, effectively removing any compressive material, and prepares the vertebral endplates for the device.  The artificial disc is then implanted into the disc space.

Anterior Lumbar Interbody Fusion (ALIF)

ALIF stands for anterior lumbar interbody fusion. It is a type of spinal fusion that decompresses nerves and stabilizes the spine from an anterior approach. It is usually indicated for patients with intractable back and leg pain with stenosis, disc herniation, and/or instability of the spine.

The surgeon accesses the spine from an anterior approach through the abdomen and uses a series of tools to remove the disc between the two vertebral bodies.  He then carefully decompresses the spinal canal, effectively removing any compressive material.  He then inserts a spacer into that space, which reestablishes the height of the disc and creates a surface area for the fusion.

Lateral Lumbar Interbody Fusion (OLIF/DLIF/XLIF)

Lateral LIF is a type of spinal fusion that decompresses nerves and stabilizes the spine from a lateral approach. DLIF stands for direct lateral interbody fusion and XLIF stands for extreme lateral interbody fusion.  The approach for DLIF and XLIF are the same but different brands of spacers are implanted (OLIF & DLIF are Medtronic spacers, XLIF is a NuVasive spacer).  It is usually indicated for patients with intractable back and leg pain with scoliosis, kyphosis, flat back syndrome, multiple level stenosis or degeneration, and/or instability of the spine. Dr. Anand specializes in minimally invasive Lateral LIFs.

An incision is made on the side of your abdomen, through which dilating tubes are passed in front of the psoas muscle down to the spine. The surgeon works through the tubes to expose the disc space.  A series of instruments are passed through the tubes to remove the disc material and prepare the space for an interbody spacer.  The interbody spacer reestablishes the height and angle of the disc and creates a surface area for the fusion.

Transforaminal Lumbar Interbody Fusion (TLIF)/Posterior Lumbar Interbody Fusion (PLIF)

TLIF stands for transforaminal lumbar interbody fusion. It is a type of spinal fusion that decompresses nerves and stabilizes the spine from a posterior approach. It is usually indicated for patients with intractable back and leg pain with stenosis, disc herniation, and/or instability of the spine. Dr. Anand specializes in minimally invasive TLIFs.

The surgeon works through the tubes to expose the bone and establish an approach to the spinal canal and nerves. He shaves the edges of the lamina and facets around the foramen (the channel where the nerve exits), thus creating the transforaminal approach to the disc space. He then decompresses the spinal canal and nerves by removing thick ligament and/or disc material that is compressing the nerves.  After that, he enters into the disc and removes the disc material. He then inserts a spacer into that space, which reestablishes the height of the disc and creates a surface area for the fusion.

The surgeon then focuses on stabilizing the spine by placing screws into the bones at each level and locking the alignment in place with rods and locking nuts. The screws and rods are placed through tubes so as to preserve the muscle attachments, further contributing to the minimally invasive approach. The procedure usually takes about 2-3 hours to complete for a one level TLIF.

Posterior Instrumentation and Fusion (PSF)

The goal of a posterior instrumentation and fusion is to stabilize the spine, reduce the curvature, and preserve the alignment.  This is achieved with a pedicle screw and rod system, which is implanted using a minimally invasive approach.  Multiple small incisions are made on the back, through which dilating tubes are placed.   The screws and rods are passed through tubes so as to preserve the muscle attachments, contributing to the minimally invasive approach.  The surgeon corrects the curve and alignment of the spine as he locks the rods into place.  By using this minimally invasive approach, patients do not need to go to ICU, lose less blood/require fewer blood transfusions, and recover much faster, allowing them to get back to their daily activities sooner. 

Deformity Correction Surgery

A deformity reconstruction procedure entails the use of multiple spinal techniques to reestablish an appropriate spinal alignment. It often combines lateral and anterior interbody fusions with a posterior instrumentation and fusion to decompress nerves and stabilize the spine. It is usually indicated for patients with intractable back and leg pain with scoliosis, kyphosis, flat back syndrome and/or multiple levels of spinal instability. Dr. Anand specializes in minimally invasive (muscle sparing) techniques for deformity reconstruction.

A deformity reconstruction is often staged over 2 days.  This allows for shorter operating times and reevaluation of the deformity between stages for final surgical planning.  The procedures are performed under general anesthesia.

The goal of the first stage (Lateral LIF and ALIF) is to restore the height of the disc spaces in the lumbar spine, while creating lordosis and a surface area for interbody fusion.  A lateral approach is taken to the spine through small 1 inch incisions on the side of the abdomen.  Dilating tubes are passed in front of the psoas muscle down to the spine.  The surgeon works through these tubes to expose the disc space.  A series of instruments are passed through the tubes to remove the disc material and prepare the space for an interbody spacer.  He then inserts a spacer into that space, which reestablishes the height and angle of the disc and creates a surface area for the fusion. The spacer is typically made of PEEK (polyetheretherketone) and is packed with BMP (bone morphogenetic protein), demineralized bone matrix, and local bone graft. These materials all contribute to enhancing the bony fusion.  This is repeated at each affected level.  Attention is then directed to the L5-S1 disc space.

For the L5-S1 disc space, as lateral access is obstructed by the pelvis, the surgeon utilizes an anterior approach to the spine.  A 1-2 inch incision is made on the front of the abdomen.  A vascular surgeon then provides access to the spine.  Once exposed, the surgeon uses a series of instruments to remove the disc and prepare the space for a PEEK interbody spacer, packed with BMP.  The spacer reestablishes the height and angle of the disc.  Both of these approaches allow him to safely access the spine while preserving muscle attachments and with the least disruption of the surrounding tissues.  The first stage procedure usually takes about 3 hours to complete for a 5-6 level lateral LIF and ALIF.  After Stage 1, patients are monitored for 2-3 days in the hospital.  Patients are encouraged to be out of bed and walking during that time.  Most patients will already notice improvement in preoperative leg pain.

The goal of the second stage (posterior instrumentation and fusion) is to stabilize the spine, reduce the curvature, and preserve the alignment.  This is achieved with a pedicle screw and rod system, which is implanted using a minimally invasive approach.  Multiple small incisions are made on the back, through which dilating tubes are placed.   The screws and rods are passed through tubes so as to preserve the muscle attachments, contributing to the minimally invasive approach.  The surgeon corrects the curve and alignment of the spine as he locks the rods into place.  By using this minimally invasive approach, patients do not need to go to ICU, lose less blood/require fewer blood transfusions, and recover much faster, allowing them to get back to their daily activities sooner.  The second stage procedure usually takes about 3 hours to complete for a 6-7 level posterior instrumentation and fusion.

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