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Alternatively, posterior percutaneous pedicle screws may be inserted.Īll surgical procedures have risk. The position is checked with an X-ray.ĭepending on the number of levels being fused a lateral plate with several bolts may be placed. The end plates of the vertebrae are prepared and a cage, which is packed with synthetic bone material, is then implanted. The disc is incised and the disc space cleared. The disc is exposed using a special retractor. There are important nerves that located within the psoas muscle and it is important to know the location of these nerves to avoid injury to them. The passage of the dilator is guided using neuro-monitoring. The position of the dilator is checked by intraoperative x-rays.
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The psoas muscle which is located on the side of the lumbar spine is then entered using a dilator. The muscles of the side of the abdomen are then split to enter the retroperitoneal space. The incision is marked on the side of the patient and the patient is then prepared. The XLIF operation is performed under a general anaesthetic with the patient laying in the lateral position on a specialised operating table. In addition, the space for the nerves within the spinal canal also becomes smaller and the nerve root may be compressed there as well. In the case of a spondylolisthesis, the exit foramen, that is the space between the bones where the nerve exits the spine, becomes too narrow. Nerve root compression causing radiculopathy is most commonly due to a disc protrusion or bony spurs (osteophytes). Finally, there may be weakness of a muscle or of a movement. Again, these may indicate the nerve root that is affected. Paraesthesia is commonly referred to as pins and needles. In addition, there is often numbness and paraesthesia. Radiculopathy is most commonly painful and the area in which the patient experiences pain will often indicate the nerve involved. Nerve roots normally supply sensation to an area of the body as well as supply various muscles to make them move. It usually will join with other nerve roots outside of the spinal canal to form various peripheral nerves. The nerve root is the start of a nerve as it exits from the spinal cord and spinal canal. It is a clinical condition usually due to compression of a nerve root. However, there are other circumstances such as degenerative scoliosis where the procedure may also be very useful. The main reasons for performing this procedure are like those for PLIF: spinal stenosis, spondylolisthesis and discogenic mechanical back pain. The procedure cannot be used at the L5/S1 level but can be used at higher levels in the spine. It is very useful in restoring disc height and in realigning the spine both coronally and sagittally.
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Alternatively, posterior percutaneous pedicle screws may be placed to provide additional stability.ĭecompression of the nerve roots relies on indirect decompression. A plate may then be placed across the vertebrae to provide further stabilisation. The spine is approached by a path behind the abdominal contents (retroperitoneal) and through a muscle called the psoas muscle.Īs part of the procedure, the intervertebral disc is removed and a large cage inserted between the vertebrae. It is a minimally invasive procedure that is performed from the lateral aspect of the body. An extreme lateral lumbar interbody infusion (XLIF) is a surgical procedure designed to stabilise the lumbar spine.