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Back - Thoracic and Lumbar Spine

Five percent of the United States population experiences back pain each year (1). Over your lifetime, you have a 60-80% chance of experiencing at least one episode of back pain. Most episodes are not severe and resolve without medical care. Some, however, are severe and disabling. But even the more severe cases which cause patients to seek medical or chiropractic care are usually transient. It has been estimated that 90% of patients who seek professional treatment for back pain will be pain free within 1-3 months. In this group of patients, after ruling out an underlying systemic cause such as a malignancy or infection, appropriate care consists of providing conservative treatment.

The gold standard of conservative treatment consists of management with NSAIDS (Non Steroidal Anti Inflammatory Drugs) and exercise therapy (chiropractic or physical therapy). If these modalities fail after a 3-6 week trial, referral to a specialist (neurosurgeon or orthopedic surgeon) is appropriate. Often, we as specialists will continue conservative measures. When this fails, surgery can be extremely effective. Surgery is only performed when conservative measures fail and diagnostic tests demonstrate abnormalities.

In our practice, the most frequently encountered causes of nerve impingement in the lumbar spine are herniated disk, spinal stenosis and painful mechanical instability with degenerated disk.

Transforaminal Lumbar Interbody Fusion (TLIF)

Fusions are performed in patients with degenerative disk disease, spondylolysthesis, recurrent herniated disks, and spinal stenosis. In fusion of the lumbar spine two or more vertebral segments are joined together, eliminating movement in the joints. The procedure is performed with the hope of reducing pain caused by movement and associated compression of the nerve roots.

While there are numerous methods available to fuse the spine, in patients whose pathology allows it, the TLIF procedure can be minimally invasive. This means that there is a reduction in the amount of muscle and skin that is damaged during surgery and there is less blood loss and post operative pain. Potentially recovery time is quicker as well.

As can be seen in the illustrations above, dilators are placed over one another in progressively larger sizes.  A tube is then placed over the dilator and the dilator removed. Instruments are used inside the tube to remove disk material and make a space for the bone implant or fusion cage.  The bone implant (Medtronic Boomerang shown here) or cage is inserted. Often, percutaneous pedicle screws are inserted to stabilize the joint while fusion occurs.

Your doctor will provide details of the procedure that is right for you as well as the benefits and risks. He will also provide instructions for your care before and after the procedure.

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