Spinal services
LUMBAR [lower back]
Anterior lumbar interbody fusion (ALIF)
This spine surgery involves approaching the spine from the front of the body to remove disc or bone material from between two adjacent vertebrae in the lower back. The vertebrae are then fused on either side of the remaining disc space using a bone graft or bone graft substitute. This is intended to resolve pain by preventing that part of your back from moving.
1 What’s involved?
The procedure may be performed either as an open surgery or using minimally invasive techniques.
A general surgeon or vascular specialist will make an incision in the abdomen to remove all or part of the degenerated disc(s). They’ll then insert a bone graft or bone graft substitute between the vertebral bodies to support the disc space and promote bone healing.
For some patients, this same procedure can be performed using endoscopic technologies. This allows surgeons to reach the affected vertebrae through small incisions and intramuscular tunnels using special guidance, illumination and surgical tools. This minimally invasive technique generally comes with lower risk and faster recovery times.
2 Why this procedure?
Typically, an ALIF is performed to treat symptoms from lumbar degenerative disc disease. This is a syndrome in which age-related wea and tear on a spinal disc causes low back pain.
There are a number of reasons your surgeon may recommend spinal fusion. This procedure is frequently used to treat:
One or more fractured (broken) vertebrae
Spondylolisthesis (slippage of one vertebral bone over another)
Abnormal curvatures of the spine, such as scoliosis or kyphosis
Protruding or degenerated discs (the cartilaginous ‘cushions’ between vertebrae)
Instability of the spine (abnormal or excessive motion between two or more vertebrae)
Low back and/or leg pain caused by degenerative disc disease, spondylolysis/spondylolisthesis, scoliosis and other spinal instability that hasn’t responded to non-surgical treatment
Depending on your condition, an ALIF may be performed alongside another spinal fusion approach. As a stand-alone technique, it is usually not recommended for people whose bones have become very soft due to osteoporosis, or in patients with instability or arthritis.
4 Potential risks or complications
As with any surgery, there are potential risks and complications that you and your physician will discuss*.
For this particular treatment, these may include: infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anaesthesia. There is also the risk that the bone graft will fail to fuse properly, a condition that may require additional surgery.
*Always consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to the anterior lumbar interbody fusion procedure.
Lumbar laminectomy
This spine surgery involves removing bone to relieve excess pressure on the spinal nerve(s) in the lumbar spine (lower back).
1 What’s involved?
Through an incision made along the midline of the back, your surgeon will cut away all or part of the lamina – the arched part of the vertebrae. This relieves the source of compression and removes any other sources of compression like bone spurs or disc material.
A lumbar laminectomy also may be performed alongside a spinal fusion where a bone graft or bone graft substitute is inserted between two or more affected vertebrae to promote bone growth.
2 Why this procedure?
Lumbar laminectomy is used to treat spinal stenosis, a condition caused by a gradual narrowing of the spinal canal. This is caused by degeneration in the facet (connective) joints and intervertebral discs from arthritis or bone spurs, called osteophytes. When the spinal canal narrows, it can begin to put pressure on the nerve roots and spinal cord causing:
Back pain
Pain that radiates into the hips, buttocks and legs
Numbness, tingling and muscle weakness in the back and/or lower extremities
To determine if a lumbar laminectomy is right for you, your physician will perform a physical exam and review your medical history. They may also order an X-ray, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of your spine.
A surgical procedure such as a lumbar laminectomy is typically recommended after non-surgical treatment options (medication, rest, physical therapy) fail.
4 Potential risks or complications
As with any surgery, there are potential risks and complications that you and your physician will discuss*.
For this particular treatment, these may include: infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anaesthesia. There is also the risk that the bone graft will fail to fuse properly, a condition that may require additional surgery.
*Always consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to the lumbar laminectomy procedure.
Lumbar microdiscectomy
This operation uses a surgical microscope and microsurgical techniques to treat pinched nerves caused by a herniated – bulging – disc.
1 What’s involved?
Your surgeon will make a small incision in your lower back, then using microsurgical instruments they’ll locate the pinched nerve and determine the pressure on the nerve. Your surgeon will then remove the herniated portion of the disc, as well as any disc fragments.
2 Why this procedure?
When a herniated disc puts pressure on one or more nerve roots it can irritate neural structures in your lower back causing:
Debilitating leg pain
Weakness and/or numbness in the legs and/or feet
Bowel/bladder incontinence
4 Potential risks or complications
As with any surgery, there are potential risks and complications that you and your physician will discuss*.
*Always consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to the lumbar microdiscectomy procedure.
Spinal fusion surgery
This surgery involves joining or fusing adjacent vertebrae using a graft to promote bone growth. The graft material acts as a bind, helping to maintain normal disc height. As the body heals, the vertebral bone and bone graft eventually grow together to join the vertebrae and stabilise the spine.
The procedure may be performed using minimally invasive surgical techniques.
1 What’s involved?
There is a variety of surgical approaches and procedures that can involve spinal fusion, but all involve the placement of a bone graft or synthetic bone graft material between vertebrae.
Posterior lumbar interbody fusion (PLIF)
Anterior lumbar interbody fusion (ALIF)
Transforaminal lumbar interbody fusion (TLIF)
Your surgeon also may decide that more than one approach is necessary.
2 Why this procedure?
Spinal fusion is typically recommended only after conservative treatment methods fail.
This procedure is frequently used to treat:
One or more fractured (broken) vertebrae
Spondylolisthesis (slippage of one vertebral bone over another)
Abnormal spine curvature such as scoliosis or kyphosis
Protruding or degenerated discs (the cartilaginous ‘cushions’ between vertebrae)
Spine instability (abnormal or excessive motion between two or more vertebrae)
4 Potential risks or complications
As with any surgery, there are potential risks and complications that you and your physician will discuss*.
For this particular treatment, these may include: infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anaesthesia. There is also the risk that the bone graft will fail to fuse properly, a condition that may require additional surgery.
*Always consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to the spinal fusion procedure.
Transforaminal lumbar interbody fusion (TLIF)
This surgery approaches the spine from the back of the body to place a bone graft between two vertebrae.
TLIF is a variation of the posterior lumbar interbody fusion (PLIF) and provides 360-degree fusion. It has a lower risk of complications compared with surgery that accesses the spine from the front of the body. It also decreases manipulation of neural structures, reduces damage to ligamentous elements and minimises excessive bone removal. It enhances biomechanical stability and provides early mobility.
The procedure may be performed using minimally invasive surgical techniques.
1 What’s involved?
Your surgeon will make a small incision over the affected vertebra(e) to remove the lamina (the ‘roof’ of the vertebra. The disc material is then removed from the front of the spine and a bone graft inserted into the disc space. The bone graft material acts as a bridge or scaffold on which the new bone can grow – with the ultimate goal of restoring spinal stability.
2 Why this procedure?
A spinal fusion procedure such as a TLIF may be recommended if you have conditions causing spinal instability in the lower back that haven’t responded to conservative treatment measures. These conditions may include degenerative disc disease, spondylolisthesis or spinal stenosis. The symptoms of lumbar spinal instability may include pain, numbness and/or muscle weakness in the low back, hips and legs.
4 Potential risks or complications
As with any surgery, there are potential risks and complications that you and your physician will discuss*.
For this particular treatment, these may include: infection, nerve damage, blood clots, blood loss and bowel and bladder problems, along with complications associated with anaesthesia. There is also the risk that the bone graft will fail to fuse properly, a condition that may require additional surgery.
*Always consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to the transforaminal lumbar interbody fusion procedure.
Minimally invasive anterior lumbar interbody fusion
If this surgery is right for you, it can be an effective treatment for disc damage caused by injury or degeneration.
1 What’s involved?
Your surgical team will place a lumbar roll at the base of the lumbar spine, and then X-ray to locate the ideal spot for surgical incision.
Under X-ray guidance, your surgeon will insert two threaded cylindrical tapered cages into the disc space. These are packed with an artificial bone graft.
You’ll be X-rayed again to confirm that the treatment has been effective.
2 Why this procedure?
This surgery is most appropriate for people with disc injuries or degeneration at the L5/S1 level – around the lower back. Ideally, you’ll have undergone a course of non-operative treatment to ensure the best possible posture correction, core muscle control and suitable weight.
After this, if you’re still experiencing intense pain your surgeon may recommend this procedure.
4 Potential risks or complications
As with any surgery, there are potential risks and complications that you and your physician will discuss*.
For this particular treatment, these may include: infection, nerve damage, blood loss, deep venous thrombosis or transient radiculopathy secondary to the bone graft (severe reaction to the bone graft substitute). There is also the risk that the bone graft will fail to fuse properly, a condition that may require additional surgery.
*Always consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to the minimally invasive anterior lumbar interbody fusion procedure.
