The human spine is a well-protected structure of bones and joints surrounded by muscles and supporting soft tissues. Often we come to learn about its unique structure when experiencing a problem, such as leg or back pain.
Your low back, or lumbar spine, bears the majority of the load for the spine. It holds the weight and supports almost every type of movement that your body performs. Because the lumbar spine is under almost constant physical stress its structure may begin to fail over time. This is why the lumbar spine is so commonly the source of back pain.
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Conditions Contributing to Lower Back Pain
Some conditions that can compromise the normal structure of the spine and result in nerve compression and pain include spinal stenosis, spondylolisthesis and degenerative disc disease.
Spinal Stenosis is the narrowing of the canal that surrounds the spinal cord. The narrowing can be caused by the enlargement of joints, arthritis, bone spurs or the calcification of ligaments in the spine. As the canal narrows, pressure may be placed on nerves causing pain and/or numbness felt in the back and legs.
Spinal Stenosis is typically a degenerative condition most common in older adults – years of wear-and-tear contribute to the condition. It is also possible to be born with Spinal Stenosis.
• Low back pain
• Weakness, tingling, numbness or pain in legs
• Standing or walking brings on symptoms
• Rest may reduce symptoms
• Leaning forward often relieves symptoms
Spondylolisthesis occurs when one vertebra slips forward in relation to an adjacent vertebra. The degree of slippage is classified in grades: Grade I being the least amount of slippage, Grade IV the most.
Spondylolisthesis may be the result of improper lifting of heavy items, weightlifting, or high impact sports, such as football or gymnastics. Many people affected experience no pain or symptoms.
• Low back pain
• Lordosis (Swayback)
• Pain and/or weakness in legs
• Tightness in the hamstrings (muscles at back of thigh)
• Symptoms grow worse with exercise
Degenerative Disc Disease is a term used to describe the gradual deterioration of the intervertebral discs that may occur naturally with the aging process or as result of injury.
Loss of hydration in the disc can shrink the disc and compromise its ability to act as a shock absorber between each vertebra.
Loss of disc height can place pressure on the nerve roots causing pain in the buttocks and legs.
Ruptured discs can bulge and put pressure on nerves
causing leg and back pain.
• Low back pain
• Pain in legs and/or buttocks
• Pain may increase while sitting or standing for extended time
• Pain may decrease while walking, or laying down
Traditional spine fusion techniques approach the spine directly through open incisions
ALIF - Anterior Lumbar Interbody Fusion
Traditionally an open procedure ALIF is a procedure that has been used traditionally for lumbar spinal fusions. The surgeon enters through the abdomen to access the lower portion of the spine. The risks associated with this approach are significant if the patient has had multiple abdominal procedures in the past which could have caused scarring and damage. As commonly referenced in medical literature, this approach carries risk of damaging blood vessels, nerves, and vital organs.
PLIF - Posterior Lumbar Interbody Fusion
The PLIF is traditionally an “open” surgery, in which back muscles are moved out of the way in order to perform the procedure. Because these muscles are being pulled from their attachments to the spine, the surgery can cause pain and scarring. As commonly referenced in medical literature, this approach also carries risks.
TLIF Transforminal Lumbar Interbody Fusion
TLIF procedures are performed in a similar manner to a PLIF, but more from the side of the spinal canal through a midline incision in the patient’s back. After reaching the spine, the surgeon removes a portion of the facet joint and navigates through the foramen to gain access to the disc space. This approach reduces the amount of surgical muscle dissection and minimizes the nerve manipulation required to access the vertebrae, discs and nerves. Complications and risks associated with TLIF procedures are similar to those found in PLIF procedures.
Newer, less-invasive techniques approach the spine through small, minimally invasive (MIS) incisions
There are a number of possible benefits to less-invasive surgeries, such as AxiaLIF, as compared to traditional surgical techniques.[1,2,3,4,10,11] They include:
• Minimal blood loss
• Less post-operative pain
• Improved recovery times
• Potentially shorter hospital stay
• Potentially less pain medication required
All surgeries, open or minimally invasive, have some degree of risk and/or complications. Your surgeon will work with you to discuss these risks and determine the best treatment for you.
(Axial Lumbar Interbody Fusion)
The AxiaLIF+ approach was developed to allow the surgeon to access the lumbar spine with minimal risk of damaging vital nerves, blood vessels, and muscles. The surgeon accesses your lower back through an approximately 1-inch incision next to your tailbone. The center of the degenerated disc is removed, and bone growth material is inserted in its place. This material helps bone growth over time in order to “fuse” the spine. The AxiaLIF+ implant is inserted to stabilize the vertebrae while fusion is occurring. During insertion, your surgeon can restore disc height. Your physician will add posterior implants for further stabilization of your spine after the AxiaLIF+ procedure has been performed.
As with all surgical approaches, there are risks. Some of the risks with AxiaLIF+ include bowel perforation, infection, and hematoma. There are other risks as well; you should discuss these with your surgeon in detail.
AxiaLIF Patient Guide
AxiaLIF Clinical Publications
Spine Surgery Glossary