Northshore surgeons, Dr. K. Samer Shamieh, Dr. Justin L. Owen and Dr. Jeremy James are conservative, minimally-invasive spine surgeons. At DISC of Louisiana we will work with you to treat a vertebral compression fracture non-surgically first. If the pain does not subside, a surgery will be recommended.

Fusions treating low back pain are called Lumbar Interbody Fusions. These procedures will remove parts of damaged or diseased discs and put a bone graft material in its place. Over time, the bone will grow around it and eventually fuse two parts of a vertebrae together.

 

To treat low back and leg pain, DISC of Louisiana offers three kinds of procedures accessing the spine from either the patient’s front, back or side. Dr. Shamieh, Dr. Justin L. Owen and/or Dr. James will plan a surgical procedure tailored to each patient’s specific symptoms, disease process, and other health factors.

Posterior Lumbar Interbody Fusion (PLIF)

This minimally invasive procedure could also be referred to as a Transforaminal Interbody Fusion (TLIF). A small incision is made on the patient’s back to access the lumbar spine. Patients tend to experience less post-surgical pain and recover faster from surgery using this approach.

 

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The PLIF Procedure

Incision

A small incision is made to the side of the problematic disc.

Visualization

Using the guidance of X-ray, a series of dilators of increasing size are carefully passed through muscles and soft tissues.

Retraction

A special instrument called a retractor is placed into the incision. The retractor is positioned so it holds the muscles and soft tissues to the side, allowing the surgeon to view the compressed nerve root and problematic disc.

Disc Removal

Vertebral bone and portions of the problematic disc are removed to create space for the fusion to occur. If the disc has collapsed, the bones are moved back into an anatomical position.

Implant Insertion

The disc space is prepared and a spinal implant containing bone graft is inserted into it. In some cases, the surgeon places additional bone graft or other special materials around the implant to stimulate bone growth.

Fixation

Special screws known as pedicle screws are placed into the bone. Connecting rods are inserted into the screws to provide extra stability.

Direct Lumbar Interbody Fusion (DLIF)

A Direct Lumbar Interbody Fusion may also be referred to as a Lateral Lumbar Interbody Fusion (XLIF). In a Direct Lumbar Interbody Fusion (DLIF), the surgeon approaches the damaged or diseased disc from the patient’s side, rather than the front or the back, through a very small incision, only one or two centimeters long. The surgeon is able to separate the muscles and access the spine without cutting through any muscle tissue.

 

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The DLIF Procedure

Incision

The patient is positioned on his or her side, and a very small incision is made.

Visualization

The surgeon uses X-Ray imaging to make sure the patient is positioned properly so he can access the damaged or diseased disc. A series of tubular dilators is inserted through the soft tissues and fibers of the psoas muscle to create a tiny “tunnel” through which the surgeon may view the spine and perform surgery.

Disc Removal

Using minimally invasive surgical techniques, the surgeon separates the fibers of the psoas muscle to access the vertebra(e) and damaged disc. He uses a neuromonitoring device to identify the location of spinal nerve roots and protect them. Through this tubular “portal”, the surgeon removes all or part of the affected disc.

Implant Insertion

An interbody device and bone graft are inserted into the open disc space to hold the vertebrae in place and promote a fusion. The tubular portal is removed, and the incision is closed.

Fixation

It may be necessary to place pedicle screws and rods in the patient’s back using minimally invasive techniques. This instrumentation is intended to provide additional stabilization while the bone heals or “fuses.”

 

Anterior Lumbar Interbody Fusion

An Anterior Lumbar Interbody Fusion (ALIF) is a surgical procedure utilizing a three- to five-inch incision on the front or side of the stomach, rather than the lower back. With this procedure, the muscles and nerves in your back experience less trauma, and the surgeon has direct access to the disc. The surgeon also has the option to place a much larger implant with an anterior approach. Golf star, Tiger woods had the same surgery. Read about his experience here.

 

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The ALIF Procedure

Incision

The patient is positioned on his or her back and a small, three- to five-inch incision is made on the front or side of the stomach.

Disc Removal

Once the spine is accessible, tiny instruments are used to remove parts of the affected disc. The disc wall is left behind to help contain bone graft.

Implant Insertion

A metal cage implant filled with bone graft is placed in the opened space and against the disc wall. The lumbar vertebrae re-align, and pressure is lifted from pinched nerve roots.

Fixation

Surgical screws, rods, and/or plates are used to hold the cage in place, so the bone graft can form solid bone bridge that fuses the vertebrae.

Following Surgery

After a successful lumbar fusion, the bone graft fuses with existing bone to form a single, solid vertebra. Nerve roots in your spine are no longer compressed and the anatomy of your vertebrae is restored. You should feel very little to no lower back and leg pain following a fusion.

 

Learn More about our Minimally Invasive Techniques

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Minimally Invasive Techniques

DISC of Louisiana offers spinal procedures using minimally invasive techniques. It means smaller incisions, sometimes less than an inch, that is often covered with a band-aid. The minimally invasive spine surgeon inserts special surgical instruments through the tiny incisions to access the damaged disc. Unlike traditional “open” spine surgery, entry and repair to the damaged disc or vertebrae is achieved without harming nearby muscles and tissues. Less muscle and tissue damage results in less pain and a faster recovery. Click here to learn more.

More about Robotics-assisted Spine Surgery

Robotics-assisted spine surgery is used to help the surgeons place pedicle screws along the lumbar spine during fusion procedures to help stabilize the spine. The surgeons at DISC of Louisiana pride themselves on always utilizing the latest cutting-edge technology and procedures to improve surgical accuracy and enhance our patients’ care. Northshore spine surgeons, Dr. K. Samer Shamieh and Dr. Jeremy James, are two of only a handful of doctors around the world trained to use robotics during minimally invasive spine procedures.

DISC of Louisiana uses the Globus ExcelsiusGPS to plan each patient’s surgery based on the specific anatomy of each person. Medical images are imported into ExcelsiusGPS and the surgeon uses them to determine the size and placement of each implant. ExcelsiusGPS will also guide the surgeon to the specific region of your spine to help place implants accurately. A screen will display the surgical instruments and implants through the entire procedure for your doctor to monitor. Click here to learn more.

 

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