Lumbar Spinal Stenosis

Is XLIF Right For Me?

Your physician might determine that the XLIF procedure is a good option for you if you require an intervertebral fusion at any lumbar level between L2 and L5, if you do not require direct nerve decompression through the same approach, and you may benefit from a less disruptive procedure. Example pathologies include:

• Degenerative disc disease, which may be manifested by disc herniation or disc collapse that may be located at a level adjacent to a fusion
• Degenerative spondylolisthesis (slip of one vertebra forward over another)
• Degenerative scoliosis (right/left curvature of the spine)
• Degenerative spinal stenosis

XLIF Potential Complications

Your physician might determine that the XLIF procedure is not a good option for you if you are not a good candidate for fusion surgery in general due to other medical conditions.

There are a few specific instances where the XLIF procedure cannot be performed. These instances include: some deformities with significant rotation, high-grade spondylolisthesis, and bilateral retroperitoneal scarring (from a prior abscess or abdominal surgery). Additionally, the XLIF procedure cannot be performed on the disc between the 5th lumbar and 1st sacral vertebrae.

Not everyone may be a good candidate for the XLIF procedure. Each patient should be treated individually, and a discussion of suitability should take place between patient and physician, as with any surgery.

Despite its advantages, your physician may decide that the XLIF procedure is not the most appropriate approach for you. Any generally accepted contraindication to fusion may include the following:

• Systemic infection
• Osteoporosis
• Significant comorbidities
• L5-S1
• Lumbar deformities with >30° rotation
• Degenerative spondylolisthesis > grade 3
• Bilateral retroperitoneal scarring (e.g., abscess or prior surgery)
• Need for direct posterior decompression through same approach (Second posterior microdecompression not contraindicated)

XLIF surgical procedure

Approaching the Spine

After you are positioned on your side and draped, an x-ray is taken of your spine to show the location of the operative disc space. The skin is marked at this location to indicate the site of the side incision. A separate small incision will first be made toward your back. The surgeon will use his or her finger through this incision to feel the space in your side through which the instruments will pass. The finger will also guide the tubular dilators into safe position within this space. As the tubes are advanced through the muscle on the side of the vertebrae (psoas muscle), x-ray pictures and NVM5® nerve monitoring help to guide them to the appropriate spot on the spine and away from nearby nerves. Once the tubes are in place, a tissue retractor (called the MaXcess® retractor) is advanced over them, locked to the surgical table, and held open to provide lighted visibility and instrument access to the disc space.

Intervertebral Disc Removal and Preparation

With the intervertebral disc now visible and accessible, the surgeon prepares the disc space for fusion by making a hole in the outer annulus, removing most of the nucleus and the annulus on the opposite side (but leaving the annulus in the front and back), and removing the cartilage from the ends of the vertebrae to reveal the bony surface beneath. Several x-rays may be taken during the disc removal to ensure adequate preparation.

Intervertebral Stabilization

With the disc space prepared, the surgeon then places a large stabilizing implant into the empty space to restore the proper disc height and support the loads put on that spinal segment. Once the intervertebral implant is in position, the retractor is removed and final confirmation x-rays are taken to document spinal alignment. The small skin incisions are closed with a few stitches and a bandage.

If further stabilization is required from behind, the surgeon might then move you to a face-down position to perform a second procedure from the back. This second procedure is also sometimes done at a later date, if deemed necessary after initial results.

Note: References to specific products as components of an XLIF procedure or other surgical procedure/approach do not imply that such products have FDA regulatory clearance or approval for all of the pathologies or indications described. The surgical procedures described on this website may not require the use of some or all of the NuVasive products found on this website. Please refer to the professional product labeling of the NuVasive products for their specific FDA cleared or approved indications of use.

Is MAS TLIF Right For Me?

Only your physician can determine if the MAS TLIF procedure is right for you. MAS TLIF may be an option if you require an intervertebral fusion at any lumbar level between L2 and S1 for the treatment of the following conditions:

• Neurologic symptoms (e.g., leg pain, numbness, bladder dysfunction, etc.)
• Recurrent disc herniation
• Spondylolisthesis (slip of one vertebra over another)
• Degenerative disc disease
• Stenosis (narrowing of space around nerves)

MAS TLIF Potential Complications

Your physician might determine that a MAS TLIF procedure is not a good option for you if you are not a good candidate for fusion surgery in general due to other medical conditions, which may include the following:

• Infection, local to the operative site
• Signs of local inflammation
• Patients with known sensitivity to the materials implanted
• Patients who are unwilling to restrict activities or follow medical advice
• Patients with physical or medical conditions that would prohibit beneficial surgical outcome
• Use with components of other systems, unless otherwise specified
• Any condition that precludes or compromises the procedure

MAS TLIF SURGICAL PROCEDURE

Approaching the Spine

After you are positioned on your belly and draped, an x-ray is taken of your spine to show the location of the operative disc space. An initial dilator is advanced and used to feel the bony target points. Once the target spot on the spine is reached and confirmed with an x-ray, sequentially larger tubes are advanced to widen the exposure. Finally, the NuVasive MaXcess® retractor is advanced, locked to the surgical table and held open to provide lighted visibility and instrument access to the disc space.

Intervertebral Disc Removal and Preparation

After removing some bone and taking pressure off of the nerves, the intervertebral disc is visible and accessible. The surgeon then prepares the disc for fusion by removing much of the intervertebral disc and removing the cartilage from the end of the vertebrae to reveal the bony surface beneath. X-rays may be taken during the disc removal to ensure adequate preparation.

Intervertebral Stabilization

With the disc space prepared, the surgeon places an intervertebral implant into the empty space to restore the proper disc height and support the loads put on that spinal segment. Once the intervertebral implant is in position, the retractor is widened to expose from the vertebra above to the vertebra below for the placement of fixation instrumentation (pedicle screws).  The NuVasive  SpheRx® pedicle screws may be placed through the MaXcess retractor using the NVM5® system, which assists with implant placement by monitoring nerve activity throughout the surgical procedure.

Once the screw construct is completed on that side, the retractor is removed and SpheRx DBR® pedicle screws are implanted through a small incision on the opposite side, also using NVM5.

The final result will be a construct with an interbody implant between the vertebral bodies, where the fusion will occur, and pedicle screw fixation posteriorly to stabilize. The two small skin incisions are closed with a few stitches and a bandage.

Note: References to specific products as components of a TLIF procedure or other surgical procedure/approach do not imply that such products have FDA regulatory clearance or approval for all of the pathologies or indications described. The surgical procedures described on this website may not require the use of some or all of the NuVasive products found on this website. Please refer to the professional product labeling of the NuVasive products for their specific FDA cleared or approved indications of use.

Is ILIF right for me?

Only your physician can determine if ILIF is right for you. The ILIF procedure may be an option if you require a posterior decompression and interspinous fusion at any lumbar level between L2 and S1 for the treatment of the neurologic symptons (e.g., neurogenic claudication, leg pain, numbness, bladder dysfunction, etc.) related to spinal stenosis.

ILIF Potential Benefits

• ILIF minimizes destabilization of the spine.  ILIF utilizes a minimally disruptive decompression procedure called a laminotomy, which involves temporary distraction (opening up) of the space between the spinous processes, and careful removal of only small sections of bone to relieve the pressure on the spinal cord and nerves.
• ILIF utilizes a minimally disruptive stabilization device to help prevent instability following a decompression surgery.  A small plate is attached to both spinous processes to stabilize the segment of the spine and promote fusion, eliminating the need for more extensive surgery
• ILIF utilizes a uniquely designed interspinous spacer to provide distraction, decompression, and fusion (growth and connection of two bones). A precision-machined allograft (donor) bone is placed between the spinous processes to accomplish the following:
  • Permanently distract (open up) areas that are pressing on the spinal cord and/or nerves. This is known as indirect decompression.
  • Promote a fusion (growth and connection of two bones) between the spinous processes to provide long-term spine stabilization.
  • Provide a protective cover for the spinal cord to help prevent scar tissue from pressing on the spinal cord and/or nerves.

ILIF Potential Complications

It is important to understand all the associated risks of surgery and the potential complications that can result. These complications may include, but are not limited to, the following:

• Fracture of spinous process
• Allergic reaction
• Mechanical failure of the spinous process plate
• Movement of the allograft spacer out of proper position
• Non-fusion (known as pseudoarthrosis)

ILIF Surgical Procedure

Decompression

As part of the ILIF procedure, your surgeon may perform a procedure called a decompression, which involves removing bone and/or a ligament that is “pressing” on the spinal cord and/or nerve roots. The surgeon will use instruments to temporarily distract (open up) the space between your spinous processes and will carefully remove small bony sections to relieve the pressure on the spinal cord and/or nerves.

Approaching the Spine

Your surgeon will make a small posterior midline incision at operative level(s), then distract (open up) and carefully perform a decompression (removal of bone and/or a ligament) to treat the stenosis.

Allograft Placement 

Your surgeon will place a small precision-machined allograft (donor) bone (ExtenSure® H2™) in the space between your spinous processes. This allograft bone will help to hold open the space between your spinous processes, providing decompression of the spinal cord and/or nerves. Allograft bone is used because the goal is to achieve a fusion (growth and connection of two bones) between the spinous processes.

Spinous Process Plate Insertion

Your surgeon will clamp a small spiked plate (e.g., Affix® II) onto the spinous processes. This plate will securely lock onto the spinous processes and hold the allograft in place to promote fusion by minimizing motion.  A biologic (bone graft material) to promote fusion is placed between the spinous process plate (e.g., Affix II plate), down onto the dorsal aspect of the allograft (e.g., ExtenSure H2 graft), to fill the space between the spinous processes.

Note: References to specific products as components of an ILIF procedure or other surgical procedure/approach do not imply that such products have FDA regulatory clearance or approval for all of the pathologies or indications described. The surgical procedures described on this website may not require the use of some or all of the NuVasive products found on this website. Please refer to the professional product labeling of the NuVasive products for their specific FDA cleared or approved indications of use.