How surgery in your side can solve a bad back

PIONEERING surgery to fix worn-out spinal discs is being carried out by British doctors who get to the vertebrae through an incision in the patient’s side. Spinal surgery to fuse bones in the lower back in order to alleviate longterm pain is usually carried out through the abdomen or from the back of the body.

However, this runs the risk of damaging major blood vessels, or organs such as the bowel, and the spinal nerves.

The pioneering new procedure, known as extreme lateral interbody fusion (XLIF), is carried out with specialised instruments inserted through the flank area.

During the procedure, a special probe placed into a back muscle sends warning signals to a monitor if surgical instruments get too close to vital nerves and arteries.

Real-time X-ray monitoring is also used to ensure the least possible collateral damage.

Although there is still risk of injury, experts hope this will be lower than with other spinal surgery techniques.

Patients typically go home the day after their operation, as opposed to staying in hospital for up to a week with traditional methods. Recovery time is cut from eight to four weeks.

Matt Ockendon, spinal surgeon at the Robert Hunt and Agnes Jones Hospital at Oswestry in Shropshire, has been trialling the XLIF technology – approved by the National Institute for Health and Care Excellence last week – for a year.

He said: ‘There is always a reluctance to operate on the spine unless absolutely necessary because of the risks.

‘When we operate through the tummy and back, we can see where we are going because of the size of the incision, but even then, errors can occur.

‘Going through the side is a much safer route because major blood vessels and organs are avoided, and with the XLIF instruments, a series of alerts are triggered if you are getting anywhere near these vital nerves when you are making your way through to the spine.

‘Normally, recovery in terms of going back to work and driving a car can take up to eight weeks.

‘Lateral minimally invasive surgery patients can be ready for every day activity in half the time.’

The new procedure will give hope to the thousands of British sufferers of degenerative disc disease (DDD), in which the intervertebral discs which act as ‘cushions’ between the spinal bones lose their flexibility, elasticity and shockabsorbing characteristics. The outer fibres that surround the disc become brittle and are more easily torn. At the same time, the gel at the centre of the disc dries out and shrinks.

The combination of damage to the intervertebral discs, abnormal bone growth due to increased friction and the gradual thickening of the ligaments that support the spine can all contribute to arthritis of the lower spine.

Aside from physiotherapy and intermittent use of pain medication, there is no cure.

IN SEVERE cases, the discomfort and immobility warrant surgery: spinal fusion, in which the damaged discs are removed and replaced by a stable prosthetic that is then screwed into a fixed position. Pensioner Linda Black, 65, from Shrewsbury, is now pain-free after having surgery to remove a wornout disc.

By the time she had the first of two operations to try to fix the problem, she was almost in a wheelchair.

Having had the XLIF procedure last year, she said: ‘I was out of hospital in just over 24 hours and the relief from pain was instant. I could walk anywhere I wanted for the first time in years.

‘Within a couple of weeks I was driving. Then I was able to get up into the Shropshire Hills and was walking several miles at a time.’