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Neurosurgery

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Oblique Lateral Lumbar Interbody Fusion

he likelihood of Minnesota Vikings center John Sullivan returning to the field this season dropped to close to zero recently following a second surgery on his lower back. Sullivan initially was treated via a lumbar discectomy in September of this year to repair a herniated disc. The Vikings were hoping he would be healed by midseason, but a recent weightlifting injury will keep him on injured reserve. This is not just a problem football players face. The

A new minimally invasive procedure By Hamid R. Abbasi, MD, PhD, FACS, FAANS probability that a person will suffer from lower back pain is high: approximately 80 percent

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Minnesota Physician January 2016

of all people suffer from this affliction at some point during their lifetime. Lower back pain is one of the most expensive and prevalent health conditions in the Western world, one of the most common causes of health care utilization, one of the leading causes of activity-limitation for people under 45, and the third most common cause of surgical procedures in the U.S. In numerous cases, low back pain is associated with spondylosis, the general degeneration of the spine associated with natural wear and tear that occurs in the joints, discs, and bones of the spine as people age. The vast majority of low back pain is mechanical in nature. Some examples of the mechanical causes of low back pain include intervertebral disc degeneration, herniated or ruptured discs, sciatica, skeletal irregularities such as scoliosis, spondylolisthesis, and traumatic injury. In recent years, the rate of disability due to lower back pain has increased dramatically and consequently health care costs have skyrocketed; particularly in patients with the above-mentioned disc disorders. In light of these issues, improvements in surgical treatments of disk disorders could benefit hundreds of thousands of patients annually and contribute to lower health care costs. The evolution of interbody fusion for lower back pain Following failure of conservative pain management, such as steroid injections, surgical procedures to alleviate back pain are often performed to fuse spinal discs together, thereby reestablishing correct disc height

and stopping disc movement. If a condition requires emergency care, conservative management may be passed up for surgical intervention. The standard treatment for lower back pain, Posterior Lumbar Interbody Fusion (PLIF), often leads to surgical morbidity as it is an invasive procedure that requires the stripping of muscles and soft tissue. Open Transforaminal Lumbar Interbody Fusion (TLIF) is a standard alternative to PLIF because it has been shown to cause less surgical morbidity leading to a quicker recovery. However, during the TLIF procedure, muscles are still detached and denervated and this may cause further injury. Minimally invasive (MI) TLIF was developed to address these issues. Relative to open TLIF, MI TLIF decreases blood loss and complication rates; but, surgery times are similar or may be longer. However, post-operative recovery is reduced in MI TLIF and long-term outcomes are generally as good, but not better, than for open TLIF. Oblique Lateral Lumbar Interbody Fusion (OLLIF) is a new minimally invasive surgical procedure developed at our practice that is performed to achieve spinal fusion of the lumbar vertebrae. Unlike other procedures, it can often be performed as an outpatient surgery.

Lower back pain is one of the most expensive and prevalent health conditions in the Western world. OLLIF is less invasive OLLIF is the first minimally invasive fusion procedure that is faster than open surgery. It is a state-of-the-art technique that is indicated for severe degenerative disk disease, listhesis, discogenic stenosis, and disk reherniation. With some experience, OLLIF can also correct for scoliosis and other deformities. Bony obstruction,

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