Lateral Lumbar Interbody Fusion (LLIF) in Roseville, CA

Lateral lumbar interbody fusion (LLIF) is a spinal fusion technique performed from the side of the body rather than from the back or through the abdomen. Spinal fusion procedures are performed for the relief of pain radiating from the lower back into the buttocks or legs. Interbody fusion refers to surgery in which an interverterbal disc is removed and the adjacent vertebrae are joined. The connection between the two vertebrae is accomplished through a biomechanical cage, which is typically made of either titanium or plastic. LLIF can be used to treat nerve compression, disc degeneration, spondylothesis and other painful lower back conditions. Typically, patients are indicated for a fusion rather than a laminectomy when there is instability or deformity of the bones of the spine.

Benefits and Limitations of LLIF

LLIF is different from other forms of fusion surgery because it uses a lateral, or side, approach to the spinal column. Approaches from the posterior, or back, necessitate the disturbance of muscles, nerves, blood vessels and ligaments in the back. Approaches from the anterior, or front, of the body pass through the abdominal muscles and come near the aorta and other vascular structures and urinary organs.

By approaching from the side of the body, the spine can be reached with minimal tissue damage and minimal risk. In addition, the side approach to the spine provides access to the damaged disc without requiring removal of any vertebral bone. Since the LLIF process is minimally invasive to the muscles and tissues at the site, recovery is often faster than with other fusion procedures.

LLIF, however, can only be performed on vertebrae that can be reached from the side. LLIF cannot be used to treat the lowest level of the spine (L5/S1), as the vascular anatomy and pelvis prohibits approach at this level. LLIF sometimes cannot be used to treat the second lowest level of the spine (L4/5), but this is patient-specific and based on the unique anatomy of the nerves, blood vessels, and pelvis at this level. For these reasons, LLIF is not appropriate for all patients. However, for patients that are appropriate candidates for LLIF, it is an excellent approach for minimally invasive fusion.

The LLIF Procedure

Once the incision is made, a probe is inserted to assist the surgeon in detecting compressed nerve roots and avoiding healthy nerve tissue. Dilators are used to separate and gently retract the muscles. An imaging device (fluoroscopy machine) helps to ensure precision as the surgeon removes the damaged disc and other nearby debris. This restores room for the nerves that have been compressed.

A cage (or spacer) is then inserted in the disc space. The cage is typically made of either titanium or plastic, and packed with bone graft. After insertion of the cage, either a metal plate or screws and rods are inserted in the vertebrae to maintain stability of the spine around the cage. The spinal instrumentation secure the vertebrae in place, maintaining spinal stability as the vertebrae grow together and fuse.

Once the LLIF procedure is complete, imaging is used again to confirm accurate placement. The surgeon then closes the incisions with sutures. Depending on the extent of spinal damage being addressed, the LLIF procedure typically takes between 1 and 3 hours.

Recovery from an LLIF Procedure

After undergoing an LLIF procedure, patients typically remain in the hospital overnight. A physical therapy regimen is started soon after to assist the patient in regaining strength and mobility. Certain activities may be restricted, including lifting, twisting the midsection, and bending at the waist. Many patients can return to work within a few weeks after the procedure if their employment does not require strenuous exertion. However, heavy lifting and manual labor are prohibited for 3-6 months after the procedure, depending on the extent of the surgery.

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Due to the ongoing epidemic of the novel coronavirus (COVID-19), Sierra Spine Institute has elected to proceed with measures to protect the safety of our patients, our staff, and our community.

We have instituted minimal visits in our physical office in order to promote social distancing and minimize the chance of spreading this contagion in our community. While we will continue to evaluate urgent patient care issues in our physical office, we are moving the majority of our patient visits to online platforms in order to ensure the safety of our patients, staff, and community.

If you are a new or established patient to our practice, our staff will reach out to you prior to your appointment date in order to confirm your appointment and help you set-up the online platform to proceed with the appointment. If you do require an evaluation in our physical office, our staff will help coordinate a date and time that works for you to ensure minimal patient flow through the office. Our phone lines and answering service will continue uninterrupted, and we will continue to have a physician on call 24/7 to address any urgent care needs.

Currently, Sutter Roseville Medical Center and Sutter Surgical Hospital North Valley have postponed all elective cases up to 4/10/2020. Elective surgeries beyond this date are being evaluated on a week-by-week basis.

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