I've been told that in California, they have the latest and best ways to do spinal fusions. I heard there's only a tiny incision and I can go home in a day or two. I live in Washington state but would be willing to travel there if that's true. What can you tell me about this new operation?
You may be talking about a relatively new approach to spinal fusion called extreme lateral interbody fusion (XLIF). Interbody fusion refers to the fact that after removing the disc, the surgeon inserts a metal cage, spacer, or bone graft material in the empty space. Bone is packed in and around the area to help the fusion process along. The XLIF is a new technique of reaching the disc space. The surgeon goes through the patient's side (rather than the front or back of the spine) with only disruption of the psoas (hip) muscle. There are no major organs to avoid (as with the anterior approach). There's no need to strip away large groups of muscles or cut through nerves (as with the posterior or posterolateral approach). The benefits of a minimally invasive approach of this type include decreased blood loss, shorter operative time and hospital stay, and less postoperative pain. Patients recover faster and return to work with fewer sick leave days used up compared with other fusion techniques. Another advantage of the XLIF is that a larger implant device can be slipped into the disc space. A larger implant means the load is spread out more, the spinal segment can be aligned more accurately, and there's less chance it will sink down into the endplate. The endplate is a fibrous piece of cartilage between the disc and the bone to support and cushion the disc/spinal segment junction. XLIF can only be used for fusion of the lumbar spine above the L5 level. For L5S1 fusions, the pelvic bones get in the way of the surgeon trying to reach the lumbar spine. You may be a good candidate for this type of surgery. The best thing to do is make an appointment with a local orthopedic surgeon and find out what are your treatment options. It's possible you could benefit from a more conservative (nonoperative) approach and avoid surgery altogether. If surgery is really needed, there are many different methods to consider based on each patient's individual problems, concerns, age, health status, and so on.