Oct. 28, 2016
Interbody fusion is a common treatment for correcting spinal deformity or treating spinal instability. However, traditional interbody fusion involves dissection of the paraspinal muscles, which may result in significant blood loss or pain.
Mayo Clinic neurosurgeons have extensive experience with minimally invasive procedures for interbody fusion, including lateral interbody fusion and percutaneous interbody fusion. Both procedures can offer patients minimal blood loss, less pain, shorter hospitalization and quicker recovery.
"The mainstay of spinal surgery has been removal of bone. Newer, minimally invasive procedures rely on indirect decompression, whereby the nerve roots are decompressed without removing bone," says Mohamad Bydon, M.D., a consultant in Neurosurgery at Mayo Clinic in Rochester, Minnesota, who frequently performs lateral and percutaneous interbody fusions.
Avoiding muscle disruption
Percutaneous screws and interbody spacer
Lateral (left) and anteroposterior (right) X-rays show L4-5 percutaneous screws and interbody spacer placed through an antero-psoas anterolateral approach.
Anterolateral and percutaneous interbody fusions require minimal dissection of muscle. In anterolateral interbody fusion, the spine is approached from the left side anterior to the psoas major, thereby avoiding that muscle and its many nerves. "The advantage is avoiding disruption of the posterior muscles. Dissecting the paraspinal muscles can be a major source of pain and instability down the road," Dr. Bydon notes.
The procedure can be especially helpful for a patient who has had prior fusion surgery but now needs spinal surgery above the previous surgical site. "Rather than a large dissection with possible removal of instrumentation from the prior surgery, select patients with adjacent segment disease may be approached laterally in a minimally invasive fashion," Dr. Bydon says. Blood loss is minimized — usually less than 100 cubic centimeters (cc), compared with 300 to 500 cc with an open procedure — and patients frequently return home one day after surgery.
Percutaneous screws and percutaneous interbody fusion
Anteroposterior (left) and lateral (right) X-rays show percutaneous screws and percutaneous interbody fusion at L4-5.
In cases where anterolateral interbody fusion is not recommended, percutaneous interbody fusion may be performed posteriorly through small incisions. At Mayo Clinic, intraoperative imaging is an essential component of these specialized minimally invasive spinal surgeries. Advanced neuronavigation technology minimizes patients' exposure to radiation.
"These minimally invasive techniques enable us to do spinal surgeries less disruptively, allowing for quicker recovery with lower blood loss, smaller incisions, reduced risk of infection and diminished reliance on pain medicine," Dr. Bydon says.