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MINIMALLY-INVASIVE LUMBAR FUSION

A recent, major advance is the minimally invasive approach for lumbar fusions. These are typically performed either percutaneously or through a circular tube retractor. Minimally invasive lumbar fusions do not require the large incision or the muscle retraction typically used in conventional fusions. Patients undergoing these less invasive procedures have a faster recovery time and are back to activities on an earlier basis. Another recent advance is the use of a computerized image guidance system for many patients undergoing lumbar fusion. This has the advantage of aiding the surgeon in optimal placement of screws and avoiding injury to delicate nerve tissue.

Lumbar fusion is a technique used for several different spinal problems. Lumbar fusions are typically performed for patients with evidence of spinal instability and sometimes in conjunction with lumbar laminectomy. Other patients, such as those with severe lumbar degenerative disc disease, may also be a candidates for lumbar fusion.

Until recently, all patients undergoing lumbar fusion required a bone graft either from the hip region or from a bone bank. Currently, many patients are candidates for BMP, a synthetic protein which encourages bone growth. One major advantage of the BMP is that it eliminates the need of a second operative site for bone grafting. In most patients undergoing lumbar spinal fusion, metal titanium instrumentation is also used. This will typically involve placing pedicle screws into the bone and connecting these with a rod. Some patients may also be candidates for an anterior fusion, which is performed through the abdomen.