In the XLIF procedure, the patient is placed on his side and two small incisions are made at the waist. This helps physicians operate while avoiding the dissection or retraction of the sensitive back muscles, bone or nerves. As the surgery continues, the physician fuses the vertebrae together to limit their motion. To do this, removal of the intervertebral disc(s) is required, and an implant intervertebral spacer is put in its place to restore disc height and spinal alignment. “This process usually will help bridge the space and fuse the joint,” says Dr. Etebar. “Sometimes the instability is severe enough that we must stabilize the area further with screws and rods. We can also do this minimally invasively through an incision no larger than a penny.”
For surgeons to accomplish the same results prior to the XLIF procedure, they had to make a 10-inch incision and disrupt the muscle placement. Patients would endure a significant amount of pain post-operatively, as well as a hospital stay of about four to five days.
“The XLIF requires only small incisions and disrupts very little muscle tissue,” says Etebar. “Therefore, there is very little pain with this surgery, recovery is faster and blood loss is minimal. Patients are up right away. They go home within 24 hours with a couple BAND-AIDS®.”
Dr. Etebar, whose colleagues Farhad Limonadi, MD and Alfred Shen, MD also perform brain and spinal surgeries, credits the huge technological advances made in spinal surgery for the improved patient outcomes. “We can now accomplish the same tasks as we did with traditional open procedures thanks to better optics, and better instrumentation and computer guidance,” notes Dr. Etebar. “We’re using sophisticated electrophysiological monitoring of the nerves so we can navigate around them safely. Years ago we had a handful of techniques we could offer patients, and the outcomes were variable. Now, we have a variety of techniques that we can customize to the patient and outcomes are much more predictable.”
However, Etebar cautions that minimally invasive procedures do not apply to every patient. “Only a select group of patients actually meet the criteria for minimally invasive procedures, but when we can do them the advantages to the patients are obvious. The most important thing we can do as physicians is patient education. Once we learn what the cause of the pain is and the cause of the degeneration of the spine, the symptoms and the activities the person is doing, we can get around many of the difficulties a patient experiences. Minimally invasive techniques are wonderful, but education still is really our most important tool in dealing with back pain.”