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April 10, 2007 > Got Back Pain?

Got Back Pain?

A new, minimally invasive surgery at Washington Hospital offers relief for some back pain suffers.

At one time or another, most Americans have trouble with pain in their lower back. In fact, the American Association of Neurological Surgeons (AANS) reports that, during their lifetime, 75 to 85 percent of adults in the U.S. will experience some type of pain in the area of their back called the lumbosacral spine.
At best, low back pain is uncomfortable. At worst, it is excruciatingly painful, making movement and normal function extremely difficult. The good news is that, in about 90 percent of cases, low back pain improves spontaneously or with conservative treatment and without the need for surgery. However, according to the AANS, "50 percent of all patients who suffer from an episode of low back pain will have a recurrent episode within one year."
For the one in 10 low back pain sufferers who need surgical intervention, their pain is usually due to degenerative disc disease causing recurrent herniation - or protrusion -
of one or more discs between the vertebrae in the spinal column. This bulge presses on the nerve roots in the spine, leading to extreme pain.
Over the years, doctors have developed a variety of surgical options to help patients get relief from this type of back pain. A common strategy is to remove the bulging disc and fuse the vertebrae together with bone grafts that stabilize the area. Instrumentation to create stability can include metal plates, screws, rods and cages.
One procedure of this type that has recently gained popularity is called the XLIF, or Extreme Lateral Interbody Fusion. In the past two months, doctors have begun performing this surgery at Washington Hospital.
XLIF is a minimally invasive procedure that offers major advantages for both the patient and the surgeon. It requires a smaller incision and is less traumatic to the body's normal tissues, resulting in a faster, less painful recovery.
Alternatively, with the anterior (frontal) approach to spinal surgery, surgeons must move bowels, blood vessels and any previous scar tissue to reach the operating site. This can be very risky, with the potential for tissue damage and bleeding. In men, there is also the possibility of damage to the nerves leading to erectile dysfunction. With the posterior (back) approach, a much larger incision is required and muscles must be cut, usually resulting in a much longer, more painful recovery.
"Rather than approaching the spine from the front or back, which have been the standards for doing lumbar spine surgery, we approach the area laterally, from the patient's side," explains Sandeep Kunwar, M.D., who is the co-medical director of Washington Hospital's Gamma Knife Program and was the first neurosurgeon to perform the XLIF procedure at Washington. "In addition to having the advantages of minimally invasive surgery, this approach enables us to place a larger graft between the vertebrae, usually resulting in greater long term stability of the spine. In addition, there is no need for the insertion of screws and rods in most patients. The difference is really dramatic."
Because the incision is so much smaller and less trauma is done to other tissues in the body during surgery, blood loss is minimal and most XLIF patients are able to return home from the hospital within one to three days. Dr.Kunwar also reports that the procedure results in a much higher rate of success for the spinal fusion.
"One downside is that XLIF patients usually experience pain and weakness in the hip right after surgery because we have to dilate and spread the hip muscle to reach the surgical site," says Dr. Kunwar. "However, this discomfort usually resolves in a few weeks."
The Taylor McAdam Bell Neuroscience Institute will soon offer a wide-range of neurosurgical services at Washington Hospital. The Institute will include a Minimally Invasive Spine Surgery program that specializes in reconstructive spine surgery. To learn more about these programs, visit, click on "Services & Programs" and select "Taylor McAdam Bell Neuroscience Institute" from the drop-down menu or call (510) 745-6480.

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