The Lowdown on Low Back Pain
(and Other Aches)


I am told that I need a lumbar fusion.  Are there minimally invasive alternatives?

There are several minimally invasive alternatives. A minimally invasive fusion is good for some patients. An IDET procedure is appropriate for others.

A minimally invasive fusion uses newly available techniques to replace a bad disc with bone. A traditional lumbar fusion usually included two parts. The first was the placement of a metal brace and the second was the insertion of a bone graft.

The first part of the operation was previously done through a long incision in the back. The muscles were cut, causing a great deal of pain. Using newly available devices, this can now be done with two tiny incisions that spare the muscles. The second part was done from behind or through a long abdominal incision. From behind it was necessary to retract all of the nerve roots causing scarring and pain. The long abdominal incision was also painful. We can now use a very small incision under the navel to replace the disc with bone. This causes less pain and heals more quickly.

An IDET procedure uses a heated wire which is inserted through a needle. The wire coagulates the disc. This is thought to strengthen the disc and make replacement unnecessary. The IDET procedure also deadens some of the nerves that cause pain. It takes about 20 to 30 minutes and does not require hospitalization. If an IDET does not work, a fusion can still be considered.

Although not all patients are candidates for minimally invasive surgery or IDET procedures, common sense would dictate that the least invasive, least painful, and least risky procedure should be used if possible.



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Last modified: 07/27/08