What is Lumbar Spinal Decompression?

by admin

Lower back pain has long been a prevalent health concern around the world. In 2017, the prevalence of lower back pain was estimated to be approximately 7.5% of the world’s population. This totals about 577 million people.

There are numerous causes of lower back pain, as well as countless treatments that can help relieve it. Lumbar spinal decompression is one treatment strategy for alleviating lower back pain caused by a pinched nerve. 

This article will discuss lumbar spinal decompression, when it’s implemented, and what patients can expect from the procedure. 

Why is Lower Back Pain So Common?

Imagine if the branches of a tree were as large at the top as they are at the bottom. Now, imagine that a heavy load is placed on the ends of the very highest branches. This would put an enormous amount of stress on the lower portion of the tree trunk.

This is comparable to what we experience as humans with our spinal columns. The human spinal column is like the trunk of a tree, but we’re as large on the top of the trunk as we are at the bottom. This puts a high amount of stress on the lower back, which is also called the lumbar region of the spine.  

The strain of lifting objects and twisting the spine over the course of a lifetime is exacerbated by degenerative spinal changes that occur with age. So, it’s not surprising that most of the back problems that bring patients to spinal specialists are centered in the lower, or lumbar, region of the spine.

Lumbar Spine Disorders

The stresses discussed above, along with disease and/or injury, can result in a host of spinal disorders. Bulging or herniated discs, spinal stenosis, and spondylolisthesis are among the most common.

  • Bulging disc

A bulging disc is a spinal disorder that occurs when the exterior of an intervertebral disc weakens, typically from the natural aging process. This can cause the disc to bulge out into one side of the spinal canal. 

  • Herniated disc

A herniated disc is essentially one step further than a bulging disc. It occurs when the soft interior of the disc protrudes out through a crack in the weakened disc exterior. 

  • Spinal stenosis

Spinal stenosis can result from a bulging or herniated disc, as well as a range of other factors. It’s a spinal condition characterized by an abnormal narrowing of the spinal canal.

Reduced space in the spinal canal can place stress on the spinal nerves or the spinal cord. But, decompression for lumbar spinal stenosis can effectively alleviate this stress. 

  • Spondylolisthesis

Spondylolisthesis is a condition that develops when one of the vertebrae is unstable and slips out of its regular position. The displaced vertebra settles on the vertebra beneath it. 

These disorders can place unnatural pressure on the nerves that emanate from the spinal column. This may cause pain, restricted mobility, and other symptoms of a pinched nerve.

What is a Lumbar Decompression Surgery?

Spinal decompression is a method of easing pressure on impinged spinal nerves. It can be performed either non-surgically or surgically. Lumbar spine decompression simply refers to decompression procedures performed on the lower portion of the spine.

The surgical solution for a lumbar pinched nerve involves removing a small amount of tissue from vertebrae in the lumbar region. The surgeon will remove the tissue that’s impinging, or putting pressure, on a nerve. This process is referred to as lumbar spinal decompression surgery.

How is Lumbar Decompression Surgery Performed?

There are various types of lumbar decompression surgery that may be implemented for different spinal disorders. The most common forms of surgical lumbar decompression include:

Laminectomy and Laminotomy

Laminectomy and laminotomy are two surgical methods of lumbar decompression that involve the lamina. The lamina acts like the roof of the spinal canal and protects the spinal cord. 

  • In a laminectomy, the surgeon removes the majority of the lamina at the affected spinal segment. 
  • In laminotomy, the surgeon only removes a small portion of the lamina. 


Laminoplasty is a procedure that involves making two cuts in the lamina so that it swings outward, like a door. After creating a hinge with the lamina of the affected vertebra, the spinal surgeon will position small bone wedges to keep the “door” from closing. Commonly referred to as open-door laminoplasty, this procedure can effectively alleviate pressure on the spinal nerves without removing the lamina. 


In foraminotomy, the surgeon creates more space around the area where nerve roots exit the spinal canal. This area is known as the intervertebral foramen. It acts as a passageway, linking the spinal canal to the periphery. 

By opening up the intervertebral foramen in foraminotomy, the spinal surgeon can alleviate pressure on the spinal nerves. 


Discectomy is a spinal decompression procedure that involves removing damaged intervertebral disc tissue. The spinal surgeon may remove some or all of the damaged disc, depending on the patient’s needs.

Lumbar Decompression Surgery With Spinal Fusion

Removing tissue in lumbar decompression surgery can lead to spinal instability. So, historically, spinal fusion back surgery has been performed in conjunction with lumbar decompression surgery to stabilize the spine. 

In spinal fusion, the surgeon places bone graft material in between the affected vertebrae. As weeks and months pass after the procedure, the vertebrae will fuse, forming a singular bone. By completely preventing motion in this segment, fusion effectively prevents instability following spinal decompression surgery.  

Unfortunately, lumbar decompression and fusion can have certain negative effects on the body, including:

  • Reduced range of motion

The key downside of spinal fusion is that it prevents all motion in the fused segment. This eliminates the patient’s ability to flex, twist, and bend the spine normally. As a result, patients may no longer be able to partake in their favorite sports and activities after spinal fusion surgery. 

  • Damage to adjacent vertebrae

The spinal segments that are adjacent to the fused vertebrae must undergo additional stress to compensate for the fusion. This can lead to a complication known as adjacent segment disease (ASD), with which the adjacent vertebrae deteriorate at a more rapid rate. ASD can lead to lower back pain, radiating pain, difficulty walking or standing, and neurological symptoms. 

Are Alternatives To Spinal Fusion Available?

Today, the TOPS™ (Total Posterior Spine) System provides an alternative to spinal fusion that preserves the spine’s natural full range of motion. This advanced spinal implant has been shown to provide better outcomes than fusion in clinical studies performed around the world. 

The TOPS™ System provides an important additional treatment option for individuals with moderate to severe pinched nerve symptoms. It can provide a major improvement in lower back pain for patients who don’t respond to non-surgical lumbar spinal decompression therapy.

How Long Does It Take to Recover From Lumbar Decompression Surgery?

The recovery period for lumbar decompression surgery can vary depending on the exact procedure and whether or not spinal fusion is performed. However, patients can generally expect to wait four to six weeks before reaching their expected degree of mobility and returning to work. 

Spinal fusion prolongs the recovery process for lumbar decompression surgery. It can take up to a year to fully recover from fusion. With this in mind, the TOPS™ System can significantly reduce the lumbar decompression surgery recovery time, allowing patients to return to physical activity much sooner.

Is Lumbar Decompression Surgery Serious?

Lumbar decompression surgery is an invasive procedure. So, as with any surgical procedure, it comes with certain risks.

With that said, lumbar decompression is widely performed and considered safe. Advancements in medical technology have even made minimally-invasive lumbar decompression surgery possible. This allows for greater safety and a lower risk of complications. 

If you have symptoms of a pinched nerve, don’t hesitate to talk to your doctor about the complete scope of treatment options available to you. 

What is Lumbar Spinal Stenosis?

by admin

Spinal stenosis is a prevalent spinal disorder in the U.S. and across the globe. In fact, the condition affects an estimated 250,000 to 500,000 U.S. residents. 

This spinal disorder can occur in the lower, or lumbar, region of the spine, which is known as lumbar spinal stenosis. Or, it may occur in the neck, or cervical, region of the spine, which is known as cervical spinal stenosis. Lumbar spinal stenosis is the most common form of this condition, and it’s the topic of our article. 

What is Lumbar Spinal Stenosis?

Spinal stenosis is a common condition, especially among patients who are aged 50 and over. It occurs when the spinal canal abnormally becomes narrower. The word “stenosis” can be traced back to ancient Greek and refers to narrowing, or constriction.

As the spinal canal progressively narrows over time, it strains the nerves that extend outward from the spine and travel into the extremities. This can cause a range of symptoms.

What Are Lumbar Spinal Stenosis Symptoms?

The symptoms of lumbar spinal stenosis can differ from patient to patient. However, pain, tingling, and numbness in the extremities are among the most common signs of this spinal disorder. 

Other symptoms of lumbar spinal stenosis may include:

  • Numbness or tingling in a foot or leg
  • Weakness in a foot or leg
  • Pain or cramping in one or both legs
  • Lower back pain

There might be other non-specific symptoms of spinal stenosis. So, please consult with your doctor for a precise diagnosis.

What Causes Lumbar Spinal Stenosis?

Most cases of spinal stenosis occur for unknown reasons. However, the causes of lumbar spinal stenosis are rooted in specific parts of the spine’s anatomy, such as: 

  • The intervertebral discs

An intervertebral disc is located between each of the bones in the spine. It provides cushioning for the bone and prevents damage by absorbing impact. These discs break down with age and may even become herniated, meaning that the disc interior protrudes from a crack in the disc interior. 

A damaged intervertebral disc can take up extra space in the spinal canal, potentially leading to spinal stenosis. 

  • The facet joints

The facet joints connect the vertebrae of the spine to one another. These joints support a large amount of weight and undergo a significant amount of stress. As a result, they’re vulnerable to wear and tear, as well as various injuries. Damage to the facet joints (and the cartilage within these joints) can trigger spinal stenosis.  

  • The spinal cord

When the spinal cord and/or the nerve roots become compressed, it may trigger pain and neurological symptoms. When the spinal cord and nerve roots are involved in spinal stenosis, the patient is rarely asymptomatic. 

What is Inherited Spinal Stenosis?

The narrowing, or tightening, of the spinal canal, may result from abnormal bone and/or tissue growth. or due to a hereditary disorder. This is referred to as inherited spinal stenosis. 

Some people are born with a spinal canal that’s narrower than average. This can cause the patient to experience spinal stenosis symptoms much earlier in life than the average patient. Additionally, patients who are born with scoliosis may experience spinal stenosis.

Scoliosis is an atypical, sideways curve of the spine. It’s commonly recognized and diagnosed in children and adolescents. In patients with scoliosis, the curved spine may place stress on the spinal cord, potentially leading to spinal stenosis. 

What is Degenerative Spinal Stenosis?

Degenerative spinal stenosis refers to cases of this condition that are caused by wear and tear on the spine. This is the most common type of spinal stenosis. 

Spinal degeneration is a normal effect of aging. It occurs as the intervertebral discs and facet joints weaken from repeated strain over time. Factors including a sedentary lifestyle, poor posture, obesity, injuries, smoking, and other spinal disorders (such as scoliosis) can speed up the process of spinal degeneration.  

Effects of aging that can contribute to the development of degenerative spinal stenosis include:

  • The cartilage in the facet joints gradually wears down, which increases friction in the spine and may cause bone spurs to form. 
  • The intervertebral discs become drier, flatter, and weaker. The discs may become damaged, leading to a slipped or herniated disc. 
  • As the cushioning in the spine from intervertebral discs decreases, the spinal cord and/or nerve roots can become strained. 

Leading a healthy lifestyle by exercising, eating a nutritious diet, and maintaining an optimal weight can help prevent spinal stenosis.

What Are The Best Treatments For Lumbar Spinal Stenosis?

Options for spinal stenosis treatment include:

  • Spinal stenosis exercises

Various exercises can help with spinal stenosis by improving strength and mobility in the affected areas. You can perform these exercises at home to support your lumbar spinal stenosis recovery. 

Examples of spinal stenosis exercises include:

  • Bridges

This exercise engages the glute muscles, which support the pelvis and can help reduce the strain on the lumbar spine. 

  • Pelvic tilts

This simple exercise engages the transverse abdominis, which is a deep abdominal muscle that promotes proper spinal alignment and helps protect the lower spine. 

  • Knee-to-chest exercise

This exercise stretches and helps relieve tension in the lower back muscles. It also flexes the spine, which relieves pain from spinal stenosis by temporarily creating more space in the spinal canal. 

  • Physical therapy

Physical therapy may improve symptoms of lumbar spinal stenosis by relieving pressure on the spinal cord. For lumbar spinal stenosis, physical therapy typically involves stretches for the lower back, legs, and hips, as well as strengthening exercises for the abdominal muscles, which support the lower spine. Your physical therapist may work with you on mobility exercises to improve your range of motion in the lower back. 

Additionally, physical therapy may involve treatments that can help with pain, tension, and inflammation. These treatments include heat/cold therapy, electrostimulation, massage, etc. 

  • Medication

Both over-the-counter and prescription medications may be used to reduce pain and inflammation from lumbar spinal stenosis. Talk to your doctor before starting a new medication for spinal stenosis symptoms in the lumbar spine.

Surgery For Lumbar Spinal Stenosis

In extreme cases, surgery for lumbar spinal stenosis may be recommended. Typically, doctors don’t recommend lumbar spinal stenosis surgery unless the patient has first undergone at least 6 months of conservative treatment. 

For lumbar spinal stenosis, spinal decompression surgery is often performed. This type of surgical procedure involves removing portions of the vertebrae that are impinging on the roots of nerves emanating from the spine. By relieving this pressure, the procedure gives patients symptom relief and provides the spinal nerves with enough space to heal. 

Laminectomy is the most common form of spinal decompression surgery for spinal stenosis of the lumbar region. In this procedure, the surgeon removes all or part of the lamina, which forms the ceiling of the spinal canal. Other types of spinal decompression surgery include foraminotomy and discectomy.   

Spinal Fusion in Lumbar Spinal Stenosis Surgery

Following the spinal decompression procedure, spinal fusion back surgery has traditionally been performed to stabilize the spine. Spinal fusion involves placing bone graft material in between the affected vertebrae. Over time, the bone graft will cause the vertebrae to permanently fuse.

Unfortunately, this stabilization procedure eliminates the independent motion of the fused vertebrae and can contribute to the deterioration of adjacent vertebrae. Patients can lose a significant amount of motion in the lower back after spinal fusion.

Alternatives to Spinal Fusion 

Spinal fusion alternatives, such as non-fusion implants, can offer stability without limiting the patient’s mobility after spinal stenosis surgery. The TOPS™ System, for example, provides an alternative to spinal fusion that maintains the spine’s full range of motion. It’s been proven in clinical studies conducted worldwide to provide superior outcomes than spinal fusion following spinal decompression surgery. 

Patients seeking surgical relief for an abnormal narrowing of the spine now have access to a wider range of treatment options than ever. Talk to your doctor about the best course of treatment for your needs. 

Can Spinal Stenosis Surgery Be Minimally-Invasive?

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Especially in people over the age of 50, spinal stenosis is a prominent cause of chronic back pain and neurological symptoms. When this condition isn’t improved with several months of non-invasive treatment, your doctor may recommend spine surgery. 

Patients who are concerned about the complications associated with traditional spine procedures may be interested in minimally-invasive spinal surgery. Also called MIS, minimally-invasive surgery can reduce your risk of complications, shorten your recovery, and cause less pain after the procedure. 

With the benefits of MIS in mind, can spinal stenosis surgery be minimally-invasive? Here, we’ll discuss this question and discover spinal fusion alternatives for spinal stenosis patients. 

What is Spinal Stenosis?

Spinal stenosis is a common condition that develops when the spaces in the spinal canal become narrower. With less space in the spinal canal, the nerve roots and spinal cord may become compressed. This can result in a variety of symptoms, including:

  • Back pain and stiffness
  • Sciatica, which is nerve pain that extends from the lower back to the buttocks and down the legs
  • Cramping and/or numbness in the legs
  • Lost sensation and/or a sensation of weakness in the feet
  • In severe cases, lost bladder or bowel control

What Causes Spinal Stenosis?

Most often, spinal stenosis is triggered by osteoarthritis-related spinal degeneration. Osteoarthritis is a condition that occurs when the cartilage that cushions the joints (including the joints in the spine) breaks down over time. This results in pain, stiffness, and inflammation. 

Other spinal conditions including herniated discs, spinal fractures, and bone spurs can also lead to spinal stenosis. Less commonly, patients are born with a narrow spinal canal or scoliosis (an irregular curve of the spine), leading to congenital spinal stenosis

Surgery For Spinal Stenosis

Surgery for spinal stenosis typically entails spinal decompression. The goal of spinal decompression surgery is to alleviate pressure on the spinal cord and/or spinal nerves to relieve back pain, stiffness, and neurological symptoms. 

There are multiple possible approaches to decompressive spinal stenosis surgery. These include:

  • Laminectomy

Laminectomy is the most frequently performed procedure for spinal stenosis. It involves removing some or all of the lamina, which covers the back of the vertebra. By getting rid of some or all of the bony arch at the back of the affected vertebra, your surgeon creates more room in the spinal canal. 

  • Laminotomy

Laminotomy is similar to laminectomy. However, while laminectomy involves the total removal of the lamina, laminotomy involves only partial removal of the lamina. Laminectomy and laminotomy are both performed to alleviate nerve compression. 

To determine which procedure you need, your surgeon will consider the specifics of your case. However, both types of spine surgery are conventionally performed with a posterior method. 

  • Foraminotomy 

Foraminotomy is another type of spine procedure. It’s done to expand the path where the spinal nerve roots leave the spinal canal. The name of this procedure is taken from the word “foramen”, which is defined as a passage in medical terminology. The end of the word, “otomy”, is a term meaning “to open”. 

While performing a foraminotomy, your surgeon will cut out any bone and soft tissue that’s blocking the passageway. By removing these tissues, your surgeon will effectively relieve pressure on the spinal nerve roots. 

  • Facetectomy

The facet joints are small joints that connect the vertebrae from the back of the spine. Each vertebra has two facet joints. 

In facetectomy, the surgeon fully or partially removes the facet joints of the affected vertebrae. The goal of this procedure is to assuage nerve compression on the nerve roots that run near the facet joints of the lower spine. 

  • Discectomy

Patients who experience spinal stenosis caused by a herniated (bulging) disc may need a discectomy. In this spinal procedure, the surgeon removes damaged disc tissue to eliminate strain on the spinal nerves. 

In a discectomy, your surgeon will aim to leave as much of the intervertebral disc untouched as possible. 

The Benefits of Minimally-Invasive Spinal Treatment

Minimally invasive spinal stenosis surgery presents several benefits over conventional spinal surgery. These include:

Less Postoperative Pain

During surgery, the body goes through a degree of trauma. But, minimally-invasive spine surgery limits or entirely avoids cutting through the muscles.

By reducing the trauma to your muscles and soft tissues, MIS leads to less pain after spinal procedures. This can also lessen the need for pain medication after surgery. 

Less Time in The Hospital

After undergoing spinal surgery, patients are eager to return home as fast as possible. After all, you’re bound to feel more comfortable in your own home than in a hospital bed. So, one of the most attractive benefits of minimally-invasive surgery is that it can reduce the length of your hospital stay. 

Faster Recovery

After struggling with chronic back pain, a lengthy recovery period from spine surgery can be daunting. Additionally, a lengthy recovery period can require patients to take time away from work and their favorite activities.  

Local Anesthesia

Many minimally-invasive procedures can be done with local anesthesia, rather than general anesthesia. This makes MIS safer, as the risk of severe complications is much lower with local anesthesia when compared to general anesthesia. 

Less Scarring

Though arguably a less crucial benefit than reduced pain and a faster recovery, less scarring is a perk of minimally-invasive surgery. Due to a smaller incision, MIS limits scarring after surgery. 

Lower Risk of Complications

Medical complications are a major concern among surgery patients. Minimally-invasive surgery can limit the risk of medical complications, including the risk of infection and an adverse reaction to general anesthesia. Additionally, MIS avoids excess blood loss and the problems that it can cause. 

Minimally-Invasive Spinal Stenosis Surgery

Minimally invasive surgery (MIS) is available for spinal stenosis. Methods that can be used to achieve minimally invasive spine surgery include:

  • Using small incisions to limit bleeding and scarring
  • Using specialized instruments and/or a microscopic camera to guide the surgeon
  • Moving the muscles away from the spine with a tubular retractor
  • Accessing the spine from the patient’s side, rather than the back, to avoid the large back muscles
  • Using a percutaneous placement of rods, screws, and other spinal implants for implant placement without disturbing the spinal muscle
    • A percutaneous placement involves using x-ray imaging to position guidewires into the vertebrae on the same path as the screws will take. The screws can then take the route of the guidewires and help guide the rod placement. The rods can be connected to the screws and the screws can be secured into place using screw extenders that reach outside of the skin.  

Spinal Fusion and Minimally-Invasive Spinal Stenosis Surgery 

Spinal fusion is commonly performed for spinal stenosis surgery. By fusing two or more of the injured vertebrae together, fusion provides stability and pain relief. However, spinal fusion isn’t conventionally a minimally-invasive procedure. 

The Downsides of Spinal Fusion Surgery

Along with the risks of a non-MIS procedure, traditional fusion also presents risks of its own. For one, fusion significantly lengthens the amount of time that the patient must remain in the hospital after spine surgery. Additionally, the complete recovery period after spinal fusion can last as long as a year. 

One of the most prominent downsides of spinal fusion is the fact that it can limit patients’ mobility. In the area of the fused vertebrae, patients often lose the ability to bend, rotate, and flex the back. This can prevent patients from taking part in their favorite activities after fusion surgery.

Thankfully, minimally-invasive spinal fusion surgery is possible with the help of innovative spinal implant systems. 

Spinal Implants For Minimally-Invasive Spinal Stenosis Surgery

Some implant systems can facilitate minimally-invasive spinal stenosis surgery and serve as spinal fusion alternatives. By stabilizing the spine without preventing motion, an implant can help resolve spinal stenosis without the need for fusion. 

The TOPS spinal implant is one of the available alternatives to spinal fusion that can allow for a minimally-invasive procedure. It’s a mechanical device that replaces the tissues removed in spinal decompression surgery. The implant works by instituting a controlled range of motion in the spine.  

Minimally-Invasive Spinal Fusion Surgery Recovery Time

The minimally-invasive spinal stenosis surgery recovery time is much shorter than that of conventional spine surgery. With the TOPS System, patients can regain a complete range of motion immediately after the procedure. Additionally, in comparison to fusion, TOPS patients are subject to far fewer restrictions during the recovery period. 

Non-Surgical Alternatives to Spinal Stenosis Surgery

Patients looking to entirely avoid spinal surgery may achieve symptom improvement from ongoing non-surgical treatment. Treatment options include:

  • Physical therapy
  • Chiropractic care
  • Massage therapy
  • Acupuncture
  • Anti-inflammatory medication
  • Epidural steroid injections
  • Lifestyle and activity modifications

Your doctor can advise you on the best approach for surgical or non-surgical treatment to resolve symptoms of spinal stenosis, including proven and less invasive solutions like the TOPS spinal implant

What Is XLIF?

by admin

Thanks to breakthroughs in spinal medicine, patients today can benefit from treatment regimens and procedures tailored to their individual needs and specific conditions. Among these recent advances on the surgical front is eXtreme Lateral Interbody Fusion, or XLIF.

What is XLIF Spine Surgery?

XLIF refers to a type of spine fusion surgery. In this procedure, the surgeon reaches the spinal disc from the side of the body, which is known as a lateral approach. This is unlike other methods, which access the spine anteriorly (from the front of the body) or posteriorly (from the back of the spine)

For patients suffering from symptoms of spinal conditions, XLIF spine surgery is to assuage nerve root compression in the spine, correct spinal deformities, and resolve spinal instability. 

XLIF Procedure Process

XLIF is among the endoscopic spine surgery procedures performed with microsurgery tools and techniques. It’s generally performed with general anesthesia, so the patient is asleep through the procedure. Additionally, XLIF takes about an hour to complete. 

Electromyography in XLIF

Nerves extending from the backbone are positioned near the psoas, which can be compromised during surgery. To avert nerve damage, the XLIF procedure utilizes electromyography (EMG), a type of neuromonitoring. This enables the surgeon to examine the nerves that emerge out of the spine throughout the procedure, making sure that they’re not inflamed or damaged.


XLIF falls into the category of back surgery involving the removal of the disc in the front of the spine. Then, an implant that holds a bone graft is used to replace the disc. The graft enables the two vertebrae to fuse between the disc area in a process known as spinal fusion.

For patients with chronic back pain, XLIF provides a method of spinal fusion for the treatment of several different lower back disorders.

Steps of XLIF

  1. The first step of XLIF surgery is to put the patient under general anesthesia. 
  2. Next, with the patient positioned on one side of the body, the surgeon will take x-rays. Using the information gathered from these x-rays, the surgeon can define the exact position of the intervertebral disc that will be extracted. 
  3. With the position of the disc marked on the patient’s skin, the surgeon will create an incision in the patient’s flank. The flank is located in between the hips and lower ribs. 
  4. Next, the surgeon will adjust the peritoneum aside from the abdominal wall. The peritoneum protects and encompasses the organs of the abdomen. 
  5. The surgeon will then make a second incision in the side of the body. A dilator will be placed into the incision, and the position of the dilator is checked with an x-ray. The dilator should be positioned precisely above the intervertebral disc. 
  6. To gain access to the spine, the surgeon will use a probe to separate the psoas. Then, a retractor can be used to allow spinal access. 
  7. With a path to the spine, the surgeon will remove the nucleus (interior) of the affected intervertebral disc. This step, which is referred to as discectomy, preps the area for fusion. 
  8. A spacer containing bone graft material will then be placed into the disc area. The spacer maintains the position of the vertebrae and helps with the fusion process. 
  9. In some cases, the surgeon may opt to complete posterior fixation with rods and facet/pedicle screws. This step can provide spinal stability after XLIF surgery. 

How Does XLIF Differ From Conventional Spine Procedures?

XLIF differs from the traditional posterior approach for spine surgery, which is called posterior interbody fusion (PLIF). Since PLIF involves reaching the spine from the back, the procedure requires the surgeon to disturb the large back muscles. Doing so triggers a lengthy recovery process, along with significant pain in the post-op period. 

Additionally, XLIF is a minimally-invasive form of spine surgery, unlike PLIF. Along with a shorter recovery period and less postoperative discomfort, minimally-invasive procedures offer the benefit of a lower risk for medical conditions.  

What Are The Benefits of XLIF?

  • Requiring only small incisions, XLIF surgery minimizes tissue damage, blood loss. and scarring. 
  • XLIF has a relatively quick recovery time, especially when compared to conventional spine surgery.
  • Taking as little as an hour to complete, XLIF minimizes the amount of time that the patient spends under anesthesia. 
  • Since the back muscles, ligaments, and bones are left undisturbed with the lateral approach of XLIF, patients experience less pain. 
  • After XLIF, patients can return to their regular activities faster than through conventional spine surgery. 
  • Patients can often walk on the day of the XLIF procedure. 
  • Although some XLIF cases may require the patient to stay for one night at the hospital, it typically results in a quicker hospital stay than other spinal procedures. After conventional spinal fusion, patients must remain in the hospital for multiple days after the procedure. 
  • XLIF surgery reviews are positive and indicate that the procedure can successfully reconstruct spinal deformities. 

What Are The Drawbacks of XLIF?

A drawback of the XLIF procedure is that it involves fusing vertebrae. Spinal fusion eliminates independent movement between adjacent levels.

Spinal fusion significantly lengthens the recovery period of any spinal fusion procedure. Unfortunately, even after making a full recovery, patients won’t regain a full range of motion in the spine. With each vertebra that’s fused, patients lose a degree of spinal flexibility. 

After XLIF with spinal fusion, patients may no longer be able to bend, flex, stretch, and twist the back like they once could. This can diminish patients’ ability to partake in various physical activities. 

Additionally, when two or more vertebrae are fused, they force the rest of the spine to compensate for their lack of motion. Specifically, the vertebrae on top of and below the fused spinal bone undergo increased impact. This can result in adjacent segment disease, or ADA.

With ADA, the vertebrae that are adjacent to the fused portion of the spine degenerate more rapidly. This can result in chronic back pain and neurological symptoms in the legs and feet. 

Fusion Alternatives

Non-Surgical Treatment Methods

Spinal fusion typically isn’t recommended until patients have undergone several months of conservative treatments. Nonetheless, patients looking to avoid the complications of fusion may consider continuing with non-surgical therapies, such as:

  • Physical therapy

Physical therapy can help patients improve their posture, strengthen the spine’s supporting muscles, and alleviate muscle tension. 

  • Chiropractic care

Chiropractic care can help relieve tension in the spine by enhancing spinal alignment. 

  • Lifestyle modifications and rest

Rest and lifestyle modifications can reduce the strain on the spine. Lifestyle factors including smoking, having a sedentary lifestyle, and having a high body weight can exacerbate spinal conditions.  

  • Anti-inflammatory medications

Anti-inflammatory medications can help patients manage chronic pain from spine conditions. NSAIDs, muscle relaxants, and acetaminophen are examples of medications that may benefit patients with chronic spinal pain. 

  • Epidural steroid injections

Epidural steroid injections can only be used a few times per year. However, this condition can help alleviate pain and swelling from spinal disorders. 

Spinal Implants

Today, thanks to another advance in spinal medicine – the TOPS™ System –  some patients may be able to avoid the risks and complications associated with spinal fusion. In select cases, a TOPS implant can be used in place of traditional spine fusion surgery to resolve conditions such as spinal stenosis, spondylolisthesis, and herniated discs. 

Unlike fusion, the TOPS System preserves the full range of motion of individual vertebrae. Additionally, the TOPS System has been proven to provide better outcomes than spinal fusion in clinical studies conducted around the world. This adds up to two breakthroughs in the treatment of spinal conditions, promising effective relief for many patients with back problems that require a surgical solution.

With the TOPS System, patients can avoid:

  • The lengthy recovery period associated with fusion
  • The post-operative pain that patients experience with fusion
  • The prolonged hospital stay required after fusion
  • The reduced spinal mobility caused by fusion
  • The risk of adjacent segment disease and related conditions

If you’re struggling with symptoms of a spinal disorder, talk to your doctor about the available treatment options, such as XLIF surgery and the TOPS System. 

What is Neural Claudication?

by admin

Neurologic Claudication

Recently, we addressed the topic of claudication. Claudication refers to pain typically felt in the legs as a result of vascular (blood vessel) problems or back problems (such as spinal stenosis) that can cause pinched nerves in the lower back.

Neurogenic claudication is a common symptom of lumbar spinal stenosis, which is the abnormal narrowing of the spinal canal in the lumbar (lower) spine. Neurogenic refers to the condition’s genesis in the nerves, while claudication (Latin for limp) refers to painful weakness or cramping in the legs.

The Basics of Neurogenic Claudication

Also called pseudoclaudication, neurogenic claudication occurs as a result of compression of the nerves in the lumbar spine. Neurogenic claudication is widely considered a syndrome, meaning that it involves a group of symptoms that usually develop collectively. 


As aforementioned, most cases of neurogenic claudication are triggered by spinal stenosis, which occurs when the space around the spinal cord diminishes.

Understanding Spinal Stenosis

Spinal stenosis is estimated to affect 8% to 11% of adults in the United States, according to the American Academy of Orthopedic Surgeons. It’s the most prevalent in adults over the age of 50.  

Common causes of spinal stenosis include bone spurs, bulging discs, and the thickening of ligaments in the spine.  

  • Bone spurs are solid lumps of extra bone that can develop as a result of wear and tear on the spine, such as osteoarthritis. 
  • Bulging discs, which may also be called herniated discs or slipped discs, occur when there’s a tear in the firm exterior of a spinal disc. The soft interior of the disc may push out through this crack and place stress on spinal nerves.  
  • The ligaments that support the spine and keep the vertebrae connected can stiffen with age. As a result, the ligaments may thicken and begin to take up extra space in the spinal canal. 

These spinal conditions can trigger the impingement of spinal nerves, which leads to the symptoms associated with neurogenic claudication. 

Bilateral vs. Unilateral

This syndrome may be bilateral (in both legs) or unilateral (in one leg). However, most cases of neural claudication are bilateral. 


Symptoms of neural claudication typically include pain, cramping, weakness, and tingling. These symptoms most often appear in one or both legs, the lumbar spine, and the buttocks. 

Pain from neural claudication may be triggered by walking or prolonged standing and is generally alleviated by changing position or bending the waist. Unlike vascular claudication, neural claudication can’t be alleviated simply by resting.

In severe cases, pain from this syndrome may be persistent. Without treatment, spinal stenosis and neural claudication can become a source of chronic pain. 

Treating Neural Claudication


First, your physician will need to run tests to provide a diagnosis. An x-ray, MRI, and CT scan are all often used to diagnose neural claudication and can identify stenosis, bone spurs, and slipped discs.

  • X-rays use electromagnetic beams of energy to create images of the patient’s bones. Although the spinal cord, spinal nerves, and other soft tissues generally can’t be viewed using an x-ray, this test allows for a general examination of the bone tissue in the spine. 
  • MRIs (magnetic resonance imaging) use radiofrequency energy, magnets, and computers to develop bone and soft tissue images. Unlike an x-ray, an MRI can help physicians evaluate soft tissue injuries in the spine, like a slipped disc. 
  • CT (computed tomography) scans combine x-rays and a computer to form images of soft tissues and bones.

These tests can evaluate the general condition of the spinal bones and soft tissues to determine if neural claudication is present. This, along with a physical exam and patient interview, will help your physician diagnose your spinal symptoms. 

Conservative Treatments

Conservative treatments may be sufficient to relieve neurogenic claudication. Physicians generally start patients out with a conservative treatment plan before considering surgery. 

Some of the most common non-surgical treatments for neurogenic claudication include:

  • Physical therapy

Physical therapy for neural claudication usually involves exercises for spinal flexion, abdominal exercises to improve stability, and lifestyle recommendations. Massage and heat/ice therapy may also be implemented for pain relief. 

  • Medications

Anti-inflammatory medications can help relieve pain and inflammation caused by neurogenic claudication. These medications may be found over-the-counter or prescribed, depending on the severity of the case. 

  • Injections 

Epidural steroid injections can be used to relieve pain from irritated nerves in the spine. When injected into the affected area, the steroid medication works to reduce pain signals from the injured nerves, leading to less pain and discomfort. 

Keep in mind that epidural steroid injections should generally only be applied three to six times annually. If you get too many injections, there’s a risk of decreasing the strength of the vertebrae and adjacent muscle tissue. 

spinal decompression surgery

In moderate to severe cases of neurogenic claudication that don’t respond to conservative protocols, surgery may be recommended. Spinal decompression surgery can improve your comfort and quality of life if neurogenic claudication is interfering with your daily activities. 

Spinal decompression surgery is typically performed to remove portions of the vertebrae that are impinging on a nerve. This pinched nerve is the source of pain, weakness, and cramping in cases of neurogenic claudication. 

Any procedure that relieves pressure on spinal nerves to resolve symptoms of spinal compression, including neurogenic claudication, is referred to as spinal decompression surgery. There are a few different approaches to spinal decompression, including discectomy, laminotomy, laminectomy, foraminotomy, foraminectomy, corpectomy, and osteophyte removal. 

Your surgeon will determine the best method of spinal decompression to suit your circumstances. 

Spinal Fusion

Following the spinal decompression treatment, a secondary operation is performed to stabilize the spine in the area where vertebral material was removed. In the past, spinal fusion back surgery was the sole available surgical stabilization procedure performed with spinal decompression.

Spinal fusion involves connecting neighboring two vertebrae so that they eventually form one bone. To do this, the surgeon will position bone graft material in between the vertebrae.

To keep the vertebrae in position during the bone graft’s healing process, your surgeon may also perform posterior fixation. This involves using screws and rods to reinforce the alignment of the spine. 


Although spinal fusion can prevent further damage from spinal instability, it has several downsides. For one, patients commonly need to stay in the hospital for up to four days after spinal fusion. After the patient returns home, it can take many months for the vertebrae to fuse together and for the spine to heal. 

Spine fusion surgery eliminates the natural independent motion of the fused vertebrae. It can contribute to the deterioration of adjacent vertebrae, potentially leading to further complications.  

Additionally, spinal fusion compromises the mobility of the spine. Patients may require special tools to pick up items off of the floor because they can no longer bend over after spinal fusion. 

Alternative Solutions

The TOPS (Total Posterior Solution) System provides an alternative to spinal fusion that preserves the full range of natural motion of each vertebra. It’s a mechanical device that supplants the tissues removed during spinal decompression. 

With the TOPS spinal implant, it’s possible to reinforce the stability of the spine after spinal decompression surgery without compromising the patient’s range of movement. This device moves with the spine so that the patient can resume their normal activities soon after surgery. 

The TOPS device also provides a faster, more comfortable recovery process after spinal decompression. This spinal implant reduces the trauma on the spinal tissues after decompression. 

If you experience pain that interferes with your quality of life, seek qualified medical help and get the facts about all of your treatment options. Today’s advanced procedures provide excellent outcomes for spinal conditions including neural claudications. 

Can You Get Blood Clots From Spinal Surgery?

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Spinal surgery has made significant advances in both its safety and efficiency in correcting many back problems, from traumatic spinal cord injury to degenerative diseases like spinal stenosis, spondylosis, and slipped disc. Many of these advances in spinal surgery have come in recent years due to minimally invasive microsurgical tools and techniques. Nonetheless, back surgery is a severe operation, and surgical candidates need to be aware of all facets of the procedure they’re considering – not only the benefits of the surgery but also the potential risks. One of the risks of spinal surgery is that of developing blood clots.

Any injury to the body increases the risk of a blood clot, as the injury itself stimulates the clotting process. Surgery constitutes an injury or trauma, and the body responds accordingly. Spinal surgery – which the body interprets as an injury to the spinal cord – can lead to the formation of blood clots within the veins. If such a thrombus becomes dislodged, it can block a blood vessel as it narrows, causing a stroke or heart attack, possibly resulting in paralysis or death. Proper postoperative care, medications, and the patient’s active role in the recovery process can minimize the risks of blood clots.

Table of Contents

What is deep vein thrombosis (DVT)?

Risks for thrombosis

Treatment and prevention of DVT

Why choose the TOPS™


What is deep vein thrombosis (DVT)?

That’s a postoperative disease associated with thrombus forming in the deep veins of the lower extremities. Often, it is induced by muscle atony or, simply put, lack of movement. 

DVT symptoms include:

  • swelling of the feet;
  • sudden shortness of breath;
  • acute chest pain;
  • coughing up blood;
  • increased pulse rate;
  • fainting;
  • dizziness.

To understand why you get blood clots after surgery, it’s worth analyzing the typology of thrombus. So, the hemostasis of the human body is maintained by forming blood clots (e.g., during wound healing). But sometimes, such a phenomenon has a negative impact on the body’s functioning. The thrombus is formed as a result of activation of the blood coagulation system in response to a vascular injury. The occurrence of thrombosis is also associated with a violation of the venous wall. That’s life-threatening because pulmonary embolisms from deep vein thrombosis (DVT) may happen later. A blood clot breaks off and goes through the bloodstream to the lungs, settling in the pulmonary arteries.

It may also cause some ischemic strokes or blood clots near the spine while blocking the artery that supplies the spinal cord. Its signs usually appear suddenly and can feel like a tight bandage wrapped around a torso. That’s precisely the point where the blood supply is disrupted. The thickening or narrowing of the arteries that carry blood to the spinal cord often triggers cerebrospinal strokes. 

Risks for thrombosis

Treating conditions such as slipped discs, spinal stenosis, and spondylosis is much less likely to cause complications than a hip or knee replacement. The cumulative incidence of deep vein thrombosis or DVT, also known as blood clot after surgery, steadily increases during the first two weeks and depends on the professional hospital care and factors of the patient’s preoperative condition, for example:

  • general well-being;
  • age (for older patients, it is often difficult to rehabilitate since muscle tone is weakened);
  • previous surgical procedures;
  • comorbidity (diabetes and other chronic diseases);
  • smoking, alcohol, drug status (e.g., contraceptives);
  • osteoporosis (patients are at increased risk of complications if the bone mineral density is low);
  • excess weight (pressure on the spine will be increased – this will entail negative consequences and be crowned with severe pain syndrome, especially in the first weeks of recovery);
  • pregnancy (operating on pregnant women is rare; however, they are safe for the mother and fetus if modifications of anesthetic and surgical methods are applied); 
  • genetic bleeding disorders.

One of the misconceptions is regarding the existence of inflammatory bowel disease (IBD) as a risk factor. The reality is that postoperative complications don’t occur; for the most part, they may be comorbid.

The most important concern after an operation is to prevent any negative consequences. In this case, we’re talking about two serious diseases: deep vein thrombosis and pulmonary embolism. 

Treatment and prevention of DVT

Since the thrombus has a high density, thinning drugs, namely anticoagulants, will prevent blood clotting (e.g., warfarin/ coumadin, heparin).

Note! Use the article for informational purposes only. Follow the therapeutic instructions of your doctor.

Clot busters are injected intravenously and break down clots. Filters settled in large veins can sometimes be used during therapy. Their function is to prevent pulmonary embolism. Compression stockings may also prevent puffiness (one of the signs we’ve noted above). 

Prevention of the illness in the postoperative period consists of maintaining normal body weight and good physical shape. Thus, you need to play sports, walk and avoid prolonged inactivity constantly. So, for example, it’s essential to take short walks. Discuss with your doctor how vulnerable you’re at risk of blood clotting, tell your medical history. If you suffer from comorbid diseases, such as diabetes or heart failure, ensure to report it. During the preoperative period, your goal should be to achieve a stable state of health. 

Blood clots in the back can be triggered by an invasive operation, trauma, disease. In 40% of cases, people who have suffered a cerebrospinal stroke can walk independently, 30% move with a cane, 20% are confined to a wheelchair. The scary data only makes you want to stay out of that 20% and 30%, right? Therefore, the preparatory period is significant: systematic; targeted treatment will help eliminate possible negative consequences. Anticoagulants, drugs that lower blood pressure, occupational therapy to preserve muscle function – these are all standard manipulations for preventing and treating cerebrospinal stroke. By the way, don’t forget to stick to a healthy diet – foods rich in fiber will help avoid the risks of intestinal inflammation. So take care of yourself now, not when you reap the rewards of a poor lifestyle.

Why choose the TOPS™

Anyone considering back surgery should also be aware that some procedures for treating a spinal problem may present lower risks or provide better outcomes than others. For example, the TOPS™ (Total Posterior Solution) procedure, which may be performed after spinal decompression surgery to stabilize the spine, provides better clinical outcomes than spinal fusion surgery, which was the traditional choice for spine stabilization before the introduction of the TOPS system. 

The TOPS provides for minimally invasive spine surgery and thereby significantly reduces the risks associated with DVT. Previously, when knowledge in spine treatment wasn’t as developed as today, the fusion procedure was the only available and most innovative option. The vertebrae were “glued” into a relatively rigid structure, which significantly limited movement. Even though flexion and extension weren’t possible, and the risks were very impressive, the fusion continues to be performed today. However, TOPS™ surgery has become a more acceptable alternative to treating degenerative spondylolisthesis of lumbar spinal stenosis for many younger physicians. Its advantage is movement in all axial directions, as well as stability.

The structure is implanted using a traditional posterior surgical approach, but the TOPS system exerts less force on the screws than other configurations. 


After the operation, the blood clotting mechanism in the body is very active because it’s aimed at stopping bleeding. Damage to the blood vessels around the surgical site is often the cause of DVT. Thrombus can form in the veins of the lower extremities but travel to the pulmonary veins with the blood flow, generating pulmonary embolisms, which are life-threatening. This process can last for weeks, and some symptoms can be identical to other diseases. The same shortness of breath or coughing are often warning symptoms, and if the convalescent neglects visits to the hospital or rehabilitation center, then often valuable time can be wasted. 

The TOPS solution has the added benefit of preserving the spine’s full range of motion and also has significantly lower risks of thrombosis, unlike spinal fusion, which permanently fuses adjacent vertebrae. If you’re a candidate for back surgery, make sure you understand not only the upsides and downsides but also all the alternative surgical solutions that can help you minimize the already low risks associated with advanced spinal procedures.

How soon can you return to athletics after spinal surgery?

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Near the top of the list of questions from almost every spinal surgery, the patients indicate how long they will have to wait for the following surgery before resuming their everyday activities. When it includes athletics – golf and tennis, bowling and the like, pastimes that put tremendous strain on the back – the answer becomes more complex. The factors influencing the time before patients can get back in the game include their physical condition and health. Just because one engages in strenuous physical activity doesn’t mean they are in good physical condition or health. Recovery times are faster for surgery patients in good physical shape because their bodies heal more quickly. Of course, the operation itself will play a significant role in deciding when you’ll be back on the tennis courts, golf course, taking a job, or engaging in a simple walk. The postoperative physical therapy program also plays a significant role. But the type of back surgery is the primary factor affecting the time required to get back into sports activities.

How to recover from surgery if you are an athlete or cannot live without daily activity – read further in this article.

Table of contents

  1. What does it mean to be in recovery?
  2. Exercises after surgery
  3. Conclusion

What does it mean to be in recovery?

While many people consider back surgery as the end of a promising sports career, Olympic, amateur, or professional athletes have returned to their competition after many common types of operations. General physical condition, professionalism during surgery, and spine rehabilitation affect how quickly you return to the game. Here are some tips for athletes planning to return to sport after a minimally invasive intervention. 

Follow your doctor’s recommendations

In most cases, surgeons consult about postoperative care. They depend not only on the patient’s health and medical history but also on the desire to return to sports. We previously discussed lower back surgery recovery: diet, exercise, physical therapy, massages, proper wound care, and medication support are vital aspects of recovery. Of course, you shouldn’t neglect motivation and grit to achieve success. And if your competition is right around the corner, and you’re still in the hospital ward, this is not a reason to be upset. Your orthopedic surgeon will take this into account when planning your postoperative period. Of course, everyone wants to leave and start an everyday life immediately. Still, following the recommendations, you’ll be able to return to sports faster than causing implicit harm to your body during self-rehabilitation. Returning too early cancels not only the healing but the operation’s effectiveness. 

So, a doctor’s advice may include:

  • doing certain exercises
  • wearing compression bandages, insoles, and stockings to avoid the risk of complications
  • A diet that includes vitamin and mineral complexes
  • A set of particular activities after back surgery.

Define your limits

You’d also talk to your coach about your career prospects or options (if you’re an amateur athlete) when getting approval from your PCP to return to athletics. It’s essential to be careful and aware of the limitations.

The postoperative stage depends on the patient, understanding the symptoms of complications, and a quick reaction if something goes wrong. E.g., accurately characterizing the level of pain and discomfort, reporting aches, numbness of the limbs, dizziness, suppuration in the wound area doesn’t mean a step back in the rehabilitation progress, but on the contrary, the ability to accelerate after a slight slowdown. Try to protect the spine, especially in the early stages of recovery. Respect your body and its healing times. 

Don’t forget about the course of drugs

Infections at the site of the surgical incision most often occur 2–4 weeks after the intervention. Most often, the following symptoms appear:

  • redness and suppuration at the incision site;
  • back pain that gets worse;
  • fever and fever;
  • change in consistency, odor, and color of drainage.

It’s essential to treat any of these and some other signs as they arise. If ignored, unavoidable consequences may occur. 

For patients with deep infection, a course of intravenous antibiotics is often given for about two months. Chronic contamination leads to the removal of the implant. 

Keep the wound clean: it must be washed with water and soap at least once a day. Remember to keep the wound dry for healing and crusting. It’s undesirable to utilize ointments, lotions, body creams on the operated areas. After two weeks, when the staples or stitches are removed, you may return to bathing or swimming. 

For opioid pain relievers, discontinuation usually occurs within the first few weeks, at most a month. There are other pain management options, such as using acetaminophen or non-steroidal anti-inflammatory drugs. But, as in the first case, they have their pros and cons and depend on the medical history. By combining medicines with physical therapy, you can achieve impressive results. 

It’s no secret that athletes’ dedication to the postoperative rehabilitation program greatly influences their subsequent success. Depending on overall progress in physical therapy, you may get consent to exercise, but return to activity must be gradual and gentle to avoid unnecessary risks.

Exercises after surgery

Patients, who have undergone minimally invasive TOPS™ procedures, can usually regain a full and painless range of motion. They have the greatest likelihood of returning to sport at pre-injury levels. Conversely, most exercises after spinal fusion aren’t available to athletes, and the possibility of injury increases – they’re less likely to return to athletics. Any collisions and falls will negatively affect health.

In any case, physiotherapy is a panacea for healing – movement combined with other aspects of rehabilitation can give you a chance for a better life. Let’s consider the leading practices that are useful for patients in the postoperative period.


It’s worth moving daily to improve blood circulation and speed up the healing of muscles and spine tissues. E.g., an essential therapy is walking, which can support the normal functioning of the heart and lungs. An upright position of the body is the best activity for the spine after surgery – this way, you can protect the discs from unnecessary stress. So, start with simple walks, and then work with your coach to develop your exercise program.

Bench press

That’s one of the simplest and effective therapies utilized in various types of operations. For instance, laminectomy recovery exercises are invaluable as they help protect discs and strengthen your back muscles.

This exercise is valuable because the discs hold the lower back during flexion and extension of the lumbar spine. So, to perform the training, you need to do the following steps:

  1. Lie face down with your arms parallel to your body.
  2. The back and hips should be relaxed. Gently lift your upper body while leaning on your stomach. Feel light pressure in your lumbar region.
  3. Hold this position for about two seconds and slowly lower yourself to the floor. Do ten hikes.

Straight leg raise (SLR) 

To strengthen the muscles of the lower back, it’s worth doing the SLR exercise. To do this, while lying on your stomach, slowly and alternately lift each leg up. In doing so, try to tighten your abdominal muscles. Do an exercise with a delay of two seconds at the highest point of the limb position. As before, do ten reps per set. Such a physiotherapy approach is appropriate for laminectomy, fusion, microdiscectomy, decompression, and of course, implantation.

In some cases, the surgical treatment chosen for a given spinal condition will affect not only the time needed to get back on the playing field but the degree to which you will ever be able to recover your old form. Take the stabilization procedure following spinal decompression surgery, for example. Spinal decompression is performed to relieve pressure on nerves within or emanating from the spine caused by conditions including spinal stenosis, spondylolisthesis, and other degenerative changes or as a result of spinal cord trauma. Spinal fusion back surgery has been the primary stabilization procedure. But the fused vertebrae lose their independent motion following stabilization. Often, patients are restricted from physical activity for up to 6 months while waiting for the biological fusion process to complete. Today, the TOPS™ (Total Posterior Solution) System provides an alternative to spinal fusion. The TOPS™ System, a surgical implant, stabilizes the spine while preserving each vertebra’s independent motion – and the good news is that there are no restrictions on your physical activity after surgery. That’s going to ensure better performance whenever it’s time to get back in the game.


As you improve your range of motion in your spine, it’s time to start doing more challenging activities that will help you get back to working condition. To do this, discuss a possible change in activity with a PCP and trainer and adjust the training schedule. After implantation, you don’t have to worry that you can’t perform some exercises. The TOPS™ System is an alternative to spinal fusion and allows you to perform any range of movements required for warm-up, training, and cool-down.

Preparing for Spinal Fusion Surgery, Part II

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Doctors Completing Surgery

In our last blog we began addressing the topic of preparing for spinal fusion back surgery.  We touched upon tests that may be performed, and the need to prepare physically through a conditioning regimen so your body is ready for the rigors of surgery. Here are additional points anyone considering spinal fusion should remember:

One potential complication of spinal fusion surgery is excessive bleeding. Several commonly used medications can increase bleeding, including aspirin, ibuprofen and other NSAIDs, as can anticoagulants such as warfarin. You will need to discontinue use of any such medications. Should your physician or surgeon be concerned about the risk of excessive blood loss during your spinal fusion operation, you may bank your own blood, called an autologous blood donation, before the surgery.

Be sure to discuss all the medications you are taking with your physicians, and they will advise you when (and if) you should stop taking them. Some medications could cause adverse affects in combination with the anesthetics or other medications used during the operation, and anti-inflammatory medication such as cortisone and chemotherapy can compromise the body’s ability to heal.

Failure of the bone graft to heal, called pseudarthrosis, is one of spinal fusion’s most problematic post-surgical complications. Smoking is associated with this complication, and nicotine has been shown to compromise the ability of bone cells to grow. It is imperative that smokers stop smoking prior to the surgery, and not smoke before their recovery is complete.

Before resigning yourself to spinal fusion surgery, remember that spinal problems often respond to more conservative treatments, such as physical therapy and healthy lifestyle changes. Alternative surgical procedures may also be available. For example, many candidates for spinal fusion can choose the TOPSTM(Total Posterior Solution) System instead. The TOPS System not only preserves all the natural flexion of individual vertebrae, unlike spinal fusion, but it has also been shown to have better outcomes in clinical trials around the world. Indeed, investigating alternative options is another productive way to prepare for a spinal fusion operation.

How to Prepare for Spinal Fusion Back Surgery

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Doctors Performing Surgery

Spinal fusion back surgery is often performed in conjunction with spinal decompression treatment. The decompression procedure relieves pressure on pinched nerves emanating from the spine, reducing pain and restricted mobility in limbs caused by the compressed nerve. But the spinal decompression surgery involves removing portions of vertebrae, making the spine weaker at these points. Thus, spinal fusion surgery is performed to strengthen the spine after decompression, and involves fusing two adjacent vertebrae with the use of an implant.

Preparing for spinal fusion surgery – whether performed on the lumbar, thoracic or cervical spine – is similar to preparations for any spinal operation, but there are a few specifics to be aware of. First, be prepared to be thoroughly examined before the surgery is performed, so your physicians can plan all aspects of your operation. Radiograph assessments of spinal instability, EMG to test nerve function, and an MRI, CAT, or other scan is often performed to identify nerve compression.

Your overall physical condition will also be assessed to ensure you are in sufficient health to undergo the rigors of the surgery. You will need to discuss any and all pre-existing medical conditions with your physicians, and further evaluation of such conditions may be necessary before proceeding with spine fusion surgery. In fact, one of the most important ways to prepare for spinal fusion is to get into the best physical condition possible. Being in good physical condition translates into fewer complications during surgery and faster recoveries after, among other benefits.

Spinal surgery of any kind should be considered a last resort, undertaken only if more conservative treatments have proven ineffective. But many patients undergoing spinal decompression now have an alternative procedure to spinal fusion, shown in clinical tests around the world to have better outcomes than spinal fusion. The TOPSTM (Total Posterior Solution) System stabilizes the spine without eliminating the independent motion of the individual vertebrae, as spinal fusion does. So one of the best ways to prepare for spinal fusion is to find out if an alternative solution like TOPS makes more sense than spinal fusion surgery for you or a loved one.

Back Pain and Steroid Injections

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Back Pain and Steroid Injections

Epidural injections of steroids have often been the treatment of choice for patients with a pinched nerve in the back whose symptoms did not respond to simple exercise, physical therapy, or other more conservative approaches. Steroid injections have also been offered to patients with spinal stenosis whose back pain was unrelieved by less invasive therapy. But the results of a new research study hint that injections of steroids for back pain may be less beneficial than believed. The study is small, but it still bears consideration, as the findings are statistically valid and underscore why healing is as much an art as a science.

The study of the efficacy of steroid injections for back pain examined more than 270 patients, aged 53 to 75 years old, culled from the ranks of a larger study of individuals with spinal health problems. The research subjects were followed for four years. Sixty-nine of these patients had epidural injections and 207 did not, but otherwise the patients’ symptoms were primarily the same in terms of severity, as measured by well-established scales used to measure pain in the leg and lower back. Using these scales, researchers found less improvement among those who had epidural injections than among patients who did not have injections.

Several caveats must be offered when considering the results of this research. First, as the authors readily acknowledge, factors that the researchers didn’t account for and couldn’t control may have affected or skewed the results. Nonetheless, we are seeing fresh thinking and new techniques improving outcomes for many spinal patients. For example, patients who elected to have spinal decompression surgery to relieve symptoms of pinched nerves typically opted for a spinal fusion back surgery in tandem, in order to stabilize the spine. Today, a growing number are opting for TOPSTM – the Total Posterior Solution – System, instead of spinal fusion. The TOPS system, unlike spinal fusion, preserves complete independent motion of the individual vertebrae. This is one more way that fresh thinking, and new technologies and procedures are transforming the care and treatment of back problems.