Spine surgery for damaged vertabrae

Extreme Lateral Inter-body Fusion (XLIF)

An XLIF is performed to reduce instability and improper motion between the vertebrae from lumbar 2 to lumbar 5, to restore height between the vertebrae that your disc used to provide or for bone graft material placement and instrumentation placement.

During the procedure, most of the damaged disc between the two bones that are to be stabilized is removed and a spacer is placed to restore correct spinal alignment. I also implant bone-forming cells that multiply around the spacer to bridge the space between the vertebrae and allow the bones to grow together, resulting in a “fusion.” Increased stability, improved alignment and restoration of space between the vertebrae often result in significant pain relief. There is a small two-inch incision on your side.

The XLIF procedure can be performed using a minimally invasive spine surgery technique in which two vertebrae are fused together. Special tools developed by NuVasive®, Inc., allow me to reach the spine via lateral access (from the side of the body) rather than the traditional incision in front. The benefit to this procedure is avoiding major organs and vessels. The muscles surrounding the spine are gently separated rather than cut. Special nerve monitoring takes place during this procedure. This minimally invasive approach preserves the surrounding muscle and blood supply for better healing and minimizes scarring. If further stabilization is required from behind, such as placement of rods, plates or screws, then I might move you to a face-down position to perform a second procedure from the back to give added stability while the fusion heals over the next three to six months.

Please visit www.nuvasive.com for information regarding XLIF applications and to learn more about NuVasive’s products. Not everyone is a good candidate for the XLIF procedure; therefore, each patient is considered individually.

Before your surgery date, you will undergo a pre-operative medical evaluation and a surgical risk assessment by the hospitalist group where your surgery will take place. You will be instructed to stop taking weight loss supplements, herbals, aspirin, non-steroidal medications and blood-thinning medications 

several days prior to surgery to help reduce blood loss. Any dental cavities, routine dental cleaning or dental procedures of any kind need to be completed at least six weeks before surgery to reduce your chances of seeding an infection in your surgical site. Also, wait at least six weeks until after your surgery for any dental work. Once you have have had spine surgery, it is not necessary to take antibiotic for preventive reasons when seeing the dentist in the future.

After Surgery

Total recovery time is relatively short. Most patients are able to return to their normal activities within a few weeks or months after surgery. You will spend one to three nights in the hospital following surgery, depending on your medical condition and the extent of the surgery. The area will be covered with a bandage or small dressing. You may have a Foley catheter in your bladder for urination, which would have been placed when you were under anesthesia in the operating room. It is removed the next day following surgery. Most patients are apprehensive about this, but removal by the nurse does not hurt.

Soon after surgery, if you can tolerate liquids, you may try regular food as tolerated. Go easy at first—it is normal to feel nauseated after having general anesthesia. Let your nurse know if you feel nauseated.

You will be provided physical therapy for walking while in the hospital. Most people are strong enough to go home directly from the hospital with assistance from friends or family. Some people need a walker for balance and stability for the first few days following surgery until they are stronger and more confident with walking. If you already have a walker at home or plan to borrow one, please bring it with you on the day of surgery so that the hospital physical therapist can make any necessary adjustments. If you don’t already have a walker, one will be provided for you to take home if needed.

Pain Medications: In the hospital your pain control will be transitioned from intra-venous self-administered medication (push button) to pain pills. You will be provided a prescription for the oral pain medication that works for you; your pain medication may be obtained on the way home from the hospital. Please remember that narcotic pain medications cause the intestines to move more slowly, which allows more time for your body to reabsorb water from your intestines. This can cause your stool to become dry and hard, thus causing constipation. It is recommended to take an over-the-counter stool softener (Colace, Miralax, Senekot-S, Dulcolax or Milk of Magnesia) while you are taking narcotic pain medication and to drink plenty of fluids. Your pain medication may contain an ingredient called acetaminophen or APAP. That is the generic name for Tylenol. Keep track of how many tablets you take a day and do not exceed 4,000 mg of acetaminophen in a 24-hour period. Excessive Tylenol intake can cause liver damage. After your surgery, do not take non-steroidal medications, such as, aspirin, Motrin, Excedrin, Aleve, ibuprofen, Relafen, Indocin, Naprosyn, meloxicam or Naproxen for three to six months. These medications inhibit bone fusion healing. I will let you know when it is safe to resume this class of medication.

Wound Care: Keep your incision clean and dry. There will be sutures at the top and bottom of your incision that may need to be removed at your first post-op appointment. They look like tiny plastic fishing line knots. The suture material that is underneath your skin will slowly be reabsorbed by your body as the incision heals. At times, I choose to use “skin glue” called Dermabond that does not require external sutures. If you feel the edges of this clear coating, do not peel or pick. It will come off over time. There may also be strips of tape across your wound called Steri-strips. Please leave these in place, even if they begin to curl up at the edges. They will be removed by me or my assistant at your first post-op appointment. Once you no longer notice drainage on the dressing, you don’t need to wear a dressing. Do not apply any ointments, peroxide or betadine to the incision, as these may inhibit new skin cell growth and delay complete healing of your incision. If your incision lies directly underneath your pant waistline, you may wish to keep a dressing on it to avoid friction from the waist band.

Bathing: No tub bathing or swimming for six weeks; but you may shower two or three days following your surgery. Let water run over the incision, while turning away from the full force of the stream. Pat it dry and then let it air dry.

Nutrition: Drink a can of Boost or Ensure nutritional supplement at each meal until you are back to eating three regular, nutritious meals per day. Proteins are the building blocks of healing.

Initial Activity at Home:

• No bending, twisting, stooping or lifting over five to ten pounds for at least eight weeks after surgery.
• Sleep on your back or side opposite the surgery with pillows under or between the knees for comfort.
• First week: Walk short amounts in the house every 10 to 15 minutes. Stairs are okay with help.
• Second week: Repeat first week but outside, weather permitting.
• Third week: Walk up to a half mile per day, divided doses.
• Fourth week: Walk up to one mile per day, divided doses.
• Third month: Walk up to three miles per day, divided doses.
• No driving for the first two weeks and must be off narcotic pain meds before driving.
• Use good body mechanics (always bend with your knees to lift or to pick something up from the floor).
• Physical therapy may be prescribed for you later in your recovery, depending on your progress.

Follow-up: Your first post-op appointment will be about two weeks after surgery; however, if you have concerns prior to this date, I will see you back sooner as needed. The tiny suture knots at each end of your incision will be painlessly removed and X-rays may be taken. Subsequent follow-up appointment intervals will be based on how you are progressing.

Return-to-Work: Status is determined on each individual’s progress, depending on the type of work you do, and depending on the baseline of your health and activity level prior to the surgery. In general, you may expect to be off work for the first two weeks following your surgery. You may then qualify for light duty sit-down work depending on your progress. It may take three to six months before you can return to physically demanding work, such as construction or heavy lifting. You should not drive a car, operate heavy machinery or make important decisions while you are still taking narcotic medications.

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