Minimally Invasive Spine Surgery
Should surgery be required however, our board-certified and fellowship trained surgeons are some of the most uniquely qualified in the Ark-La-Tex region. They are the only area board certified specialists who perform a full range of cervical and lumbar spinal procedures on a daily basis. Doctors Pierce Nunley, Euby J. Kerr, III, and David A. Cavanaugh are also the only spine surgeons in the Ark La Tex region that have achieved the highly esteemed board certification from the American Board of Spine Surgery. This distinction of Board Certification is only awarded to physicians that have passed rigorous curriculum based written and oral examinations and recognizes Spine Surgery as a distinctive and separate specialty.
At the Spine Institute of Louisiana, we specialize in bringing our patients the latest in spine surgery options. In cases where surgery is indicated, we use endoscopic technology for a minimally-invasive approach, lessening patient recovery time. With our techniques, we can treat many spinal conditions such as spinal stenosis, herniated discs, spondylolisthesis, scoliosis and nerve compression. Using tiny incisions, our surgeons perform some of the most remarkable advances in spinal care today. Traditional spine surgery requires longer recovery time and causes significant scarring. Minimally invasive techniques represent a new frontier in spine surgery offering significant advantages, including reduced blood loss, reduced hospital stays and a faster return to daily living.
Interbody Fusion surgical procedures represent some of the minimally invasive advances that are available to patients. Our surgeons perform a wide range of these approaches including:
AxialLIF – (Axial Lumbar Interbody Fusion). This innovative procedure is performed on the lower back using small incisions and usually takes less than one hour to complete. This procedure spares the cutting of muscle and soft tissue and has less likelihood of post-operative complications, requires less anesthesia time for the patient, and allows for a faster recovery. The spine is accessed through a small incision just above the coccyx (tailbone), the nucleus of the diseased disc is removed and bone growth material is inserted in place of the nucleus. Normal disc height is restored and the spine is stabilized with the 3D Axial Rod™ and posterior screws.
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PLIF - (Posterior Lumbar Interbody Fusion) - Posterior Lumbar Interbody Fusion is a surgical fusion , in which the vertebrae are accessed through an incision in the patient's back. Pre-operatively the surgeon uses an MRI to determine what size implant(s) the patient will need. During the surgery a 3-6 inch incision is made in the patient's back and the spinal muscles are separated by retractors to allow the surgeon access to the vertebral discs. The surgeon then carefully removes the lamina (laminectomy) to be able to see and access the nerve roots. The facet joints, which lie directly over the nerve roots, may be trimmed to allow more room for the nerve roots. The surgeon then removes the affected disc and surrounding tissue and prepares bone surfaces of adjacent vertebrae for fusion. Once the disc space is prepared, an implant is inserted to promote fusion between the vertebrae. The implant (cage) may be made of bone, metal, carbon fiber or other material. Additional instrumentation such as rods or screws will be used as needed to appropriately stabilize the spine.
TLIF (Transforminal Lumbar Interbody Fusion) – Transforaminal Lumbar Interbody Fusion surgery is a technique involves approaching the lumbar spine more from the side of the spinal canal through a midline incision in the patient's back. This approach reduces the amount of surgical muscle dissection and minimizes the nerve manipulation required to access the vertebrae, discs and nerves. The TLIF approach is generally less traumatic to the spine, is safer for the nerves, and allows for minimal access and endoscopic techniques to be used for spinal fusion. As with other fusion surgeries,, disc material is removed from the spine and replaced with bone graft (along with cages, screws, or rods if necessary) inserted into the disc space. The instrumentation helps facilitate fusion while adding strength and stability to the spine. Many different state of the art cage technologies are used.including those made of bone, titanium, polymer, and even bioresorbable materials.
ALIF (Anterior Lumbar Interbody Fusion) – Anterior Lumbar Interbody Fusion is a fusion procedure that is similar to the PLIF, except that the surgical approach is from the front of the body usually through an incision in the lower abdominal area. This incision may involve cutting through, and later repairing, the muscles in the lower abdomen. This approach preserves the muscles and allows access to the front of the spine through a very small incision, maintains abdominal muscle strength and function and can be used to fuse the L5-S1 disc space. Once the incision is made and the vertebrae are accessed, and after the abdominal muscles and blood vessels have been retracted, the disc material is removed. The surgeon then inserts bone graft (and anterior interbody cages, rods, or screws if necessary) to stabilized the spine and facilitate fusion.
XLIF (Extreme Lateral Interbody Fusion)- Our surgeons are among a select few in the United States performing XLIF, a minimally invasive fusion procedure that typically requires only one day of hospital stay. The XLIF procedure accesses the spine through the patient’s side, thus avoiding major muscles and tissues in the back. With these procedures, patients are more quickly mobile, with a typical four- week recovery period rather than the traditional months of recovery following a typical open back surgery. The disk material is removed from the spine and replaced with a bone graft, along with structural support from a cage made of bone, titanium, carbon-fiber or a polymer. A very small incision- is made, sometimes with another smaller incision just behind the first one. Special retractors are used as well as X-ray images of the spine. This muscle splitting process rather than muscle cutting reduces the amount of time in surgery as well as time to heal and rehabilitate. This technique results in less blood loss and less pain after surgery. Only those vertebra of the spine that have clear access from the side of the body can be approached using the XLIF approach.
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