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Lateral Lumbar Interbody Fusion

(LLIF)

Lateral Lumbar Interbody Fusion | Prof Aaron Buckland

Lateral Lumbar Interbody Fusion (LLIF)

LLIF is a minimally invasive surgical procedure used to treat degenerative disc disease, spondylolisthesis, and scoliosis by accessing the spine from the side to remove a damaged disc and insert an interbody cage.

Why Choose LLIF?

LLIF is favored for its minimally invasive nature, resulting in less muscle disruption, reduced blood loss, and quicker recovery compared to traditional open surgeries. The lateral approach permits the placement of larger interbody cages that provide superior support and alignment, thereby promoting successful fusion.

What Happens During LLIF Surgery?

Preparation

  • Hospital Admission: You are admitted on the day of surgery; fasting is required as per your anaesthetist’s instructions.
  • Anaesthesia: The procedure is performed under general anesthesia, ensuring you are asleep and pain-free.

Surgical Approach

  • Patient Positioning: You are positioned in a lateral decubitus (side-lying) or prone position, depending on the surgical plan.
  • Incision: A small incision is made on the side of the abdomen. The surgeon carefully dissects between the abdominal muscles, the abdomen, and the psoas muscle to access the spine using a specialized retractor system.

Disc Removal and Fusion Preparation

  • Exposing the Disc Space: The affected disc is exposed by retracting surrounding tissues. The damaged disc is then removed, allowing distraction to restore disc height.
  • Preparation for Fusion: The disc space is thoroughly cleaned and the bony surfaces prepared for the interbody cage.

Insertion of the Interbody Cage and Bone Graft

  • Interbody Cage Placement: A cage filled with bone graft material (autograft, allograft, or synthetic) is inserted into the empty disc space to restore disc height and promote fusion.
  • X-ray Verification: Intraoperative X-rays confirm correct placement and proper spinal alignment.

Supplementary Fixation (if needed)

Fixation with screws and rods may be added through a posterior approach to provide extra stability and increase fusion rates.

Closure

Once the implants are in place and alignment is confirmed, the incision is closed with sutures, and a sterile dressing is applied to protect the wound.

Pre-operative X-Ray AP

Post-operative X-Ray AP

Pre-operative X-Ray Lateral

Post-operative X-Ray Lateral

Postoperative Care and Recovery

  • Hospital Stay: Typically 1-2 days, depending on the extent of surgery and recovery progress.
  • Pain Management: Pain is managed with medications, and early mobilization is encouraged to reduce risks like blood clots and pneumonia. The lateral approach minimizes postoperative pain by sparing back muscles.
  • Outpatient Rehabilitation: A tailored physiotherapy program will start shortly after surgery to restore strength, flexibility, and proper body mechanics.
  • Activity Restrictions: Patients should avoid heavy lifting, bending, and twisting for at least 3 months, with a gradual return to normal activities guided by your healthcare team.
  • Follow-Up: Regular follow-up appointments monitor healing and fusion success.

Risks and Complications

  • Infection: A small risk exists at the surgical site.
  • Bleeding: Excessive bleeding is possible but uncommon; blood transfusions may be required in rare cases.
  • Nerve Injury: Risk of injury to the spinal or surrounding nerves, which could lead to weakness or numbness. Nerve monitoring is used to minimize this risk.
  • Non-Union: The bones may not fuse as expected, potentially necessitating additional surgery.
  • Groin/Thigh Pain: Due to retraction of the psoas muscle, groin and thigh pain may occur and usually resolves within 3-4 weeks, though persistent pain is rare.

Results of LLIF Surgery

Most patients experience significant improvements in pain and function following LLIF surgery. To learn more about Prof Aaron Buckland’s outcomes for 1-2 level lumbar fusion surgery, complex and revision lumbar fusion, and adult spinal deformity correction surgery, please click here.

Ready to take the next step? Contact our expert team today to schedule a consultation and explore your treatment options.

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