The human spine is a well-protected structure of bones and joints surrounded by muscles and supporting soft tissues. We often only come to learn about its unique structure at the time we may be experiencing a problem, such as leg or back pain. In order to understand the source of your pain, it is important to understand the structure of the healthy spine.
Your low back, or lumbar spine, bears the majority of the load for the spine. It holds the weight and supports almost every type of movement that your body performs. Because the lumbar spine is under almost constant physical stress its structure may begin to fail over time. This is why the lumbar spine is so commonly the source of back pain.
There are a number of possible benefits to less-invasive surgeries, such as AxiaLIF, as compared to traditional surgical techniques. They include:
- Minimal blood loss
- Less post-operative pain
- Improved recovery times
- Potentially shorter hospital stay
- Potentially less pain medication required
All surgeries, open or minimally invasive, have some degree of risk and/or complications. Your surgeon will work with you to discuss these risks and determine the best treatment for you.
The AxiaLIF+ approach was developed to allow the surgeon to access the lumbar spine with minimal risk of damaging vital nerves, blood vessels, and muscles.
The surgeon accesses your lower back through an approximately 1-inch incision next to your tailbone. The center of the degenerated disc is removed, and bone growth material is inserted in its place. This material helps bone growth over time in order to “fuse” the spine. The AxiaLIF+ implant is inserted to stabilize the vertebrae while fusion is occurring. During insertion, your surgeon can restore disc height. Your physician will add posterior implants for further stabilization of your spine after the AxiaLIF+ procedure has been performed.
As with all surgical approaches, there are risks. Some of the risks with AxiaLIF+ include bowel perforation, infection, and hematoma. There are other risks as well; you should discuss these with your surgeon in detail.
There are several surgical techniques available for spine fusion. Traditional techniques approach the spine directly through open incisions, while newer, less-invasive techniques approach the spine through small incisions. If you require spine fusion, the fusion techniques selected may depend on the treatment required for your particular case, individual anatomy, or on the preferences of your surgeon.
ALIF is a procedure that has been used traditionally for lumbar spinal fusions. The surgeon enters through the abdomen to access the lower portion of the spine. The risks associated with this approach are significant if the patient has had multiple abdominal procedures in the past which could have caused scarring and damage. As commonly referenced in medical literature, this approach carries risk of damaging blood vessels, nerves, and vital organs.
PLIF is traditionally an “open” surgery, in which back muscles are moved out of the way in order to perform the procedure. Because these muscles are being pulled from their attachments to the spine, the surgery can cause pain and scarring. As commonly referenced in medical literature, this approach also carries risks.
TLIF procedures are performed in a similar manner to PLIF procedures, but more from the side of the spinal canal through a midline incision in the patient’s back. After reaching the spine, the surgeon removes a portion of the facet joint and navigates through the foramen to gain access to the disc space. This approach reduces the amount of surgical muscle dissection and minimizes the nerve manipulation required to access the vertebrae, discs and nerves. Complications and risks associated with TLIF procedures are similar to those found in PLIF procedures.
Conditions Contributing to Lower Back Pain
Painful conditions of the spine may be difficult to understand because often the pain is felt elsewhere, such as in your legs or buttocks. This pain is caused by pressure placed upon the nerves that pass through your spine and extend through the rest of your body.
Some conditions that can compromise the normal structure of the spine and result in nerve compression and pain include spinal stenosis, spondylolisthesis and degenerative disc disease.
Spinal Stenosis is the narrowing of the canal that surrounds the spinal cord. The narrowing can be caused by the enlargement of joints, arthritis, bone spurs or the calcification of ligaments in the spine. As the canal narrows, pressure may be placed on nerves causing pain and/or numbness felt in the back and legs.
Spinal Stenosis is typically a degenerative condition most common in older adults – years of wear-and-tear contribute to the condition. It is also possible to be born with Spinal Stenosis.
- Low back pain
- Weakness, tingling, numbness or pain in legs
- Standing or walking brings on symptoms
- Rest may reduce symptoms
- Leaning forward often relieves symptoms
Spondylolisthesis occurs when one vertebra slips forward in relation to an adjacent vertebra. The degree of slippage is classified in grades: Grade I being the least amount of slippage, Grade IV the most.
Spondylolisthesis may be the result of improper lifting of heavy items, weightlifting, or high impact sports, such as football or gymnastics. Many people affected experience no pain or symptoms.
- Low back pain
- Lordosis (Swayback)
- Pain and/or weakness in legs
- Tightness in the hamstrings (muscles at back of thigh)
- Symptoms grow worse with exercise
Degenerative Disc Disease
Loss of hydration in the disc can shrink the disc and compromise its ability to act as a shock absorber between each vertebra
Loss of disc height can place pressure on the nerve roots causing pain in the buttocks and legs
Ruptured discs can bulge and put pressure on nerves causing leg and back pain
- Low back pain
- Pain in legs and/or buttocks
- Pain may increase while sitting or standing for extended time
- Pain may decrease while walking, or laying down
1. Tobler, et al. 2011. “Minimally-invasive Axial Pre-sacral L5-S1 Interbody Fusion: Two Year Clinical and Radiographic Outcomes” SPINE. 36(20):E1296-301.
2. Gerszten, et al. “Axial Presacral Lumbar Interbody Fusion and Percutaneous Posterior Fixation for Stabilization of Lumbosacral Isthmic Spondylolisthesis.” Journal of Spinal Disorders & Techniques. 25(2):E36-40.
AxiaLIF is a registered trademark of Quandary Medical LLC. Quandary Medical LLC holds multiple patents related to the methods and apparatuses associated with AxiaLIF.
Indication for use: AxiaLIF System is intended to provide anterior stabilization of the L5-S1 spinal segment (s) as an adjunct to spinal fusion. The system is indicated for patients requiring fusion to treat pseudoarthrosis (unsuccessful previous fusion), spinal stenosis, spondylolisthesis (Grade 1 or 2 if single-level: Grade 1 if two-level), or degeneration disc disease as defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies. Its usage is limited to anterior supplemental fixation of the lumbar spine at L5-S1 or L4-S1 in conjunction with use of legally marketed posterior fixation such as facet screw or pedicle screw systems at the same levels that are treated with system.