In this video, Dr. André talks about the different types of fusion surgery, Lumbar Spine Arthrodesis, which are surgeries that fix the spine. This type of surgery is indicated for more severe degeneration of the lumbar spine, where there is greater loss of intervertebral disc height, greater arthrosis of the joints between the vertebrae, and eventually even compression of the nerve root. It is also indicated for spondylolisthesis, which is the slipping of one vertebra over another. It is important to emphasize that spine surgery is a last resort; we always try less invasive treatments first, such as physical therapy, drug treatments, and occasionally some minimally invasive procedures, such as blocks. Check out the techniques for Lumbar Spine Arthrodesis below. Posterior Arthrodesis: The first step in this surgery is Laminectomy, where a bony part of the vertebra (Lamina) is removed, allowing access to the nerves that run down the spine. By moving these nerves to the side, it is possible to access the intervertebral disc, removing fragments of this disc, placing spacers and filling the space with bone grafts. These grafts are intended to help fix these vertebrae, which, during surgery, will receive pins and screws on both sides, increasing stability and fixing the spine. This procedure is familiar to most surgeons, who are accustomed to performing it, offering the advantage of greater safety to the patient. Another benefit is the good visualization of the nerve structures that the procedure offers, minimizing the chance of nerve damage. A disadvantage of Posterior Arthrodesis is the high manipulation of the muscles next to the spine, which can generate a source of post-operative pain. Anterior Arthrodesis: In this procedure, an abdominal incision is made, below the navel. After moving the other structures, such as blood vessels, for example, the surgeon removes the degenerated intervertebral disc. After removing this disc, the vertebra is prepared (bone scraping), which will receive a spacer, which is fixed with a plate, preventing it from moving, fixing the spine. This technique is only possible for the lower discs (L4-L5 and L5-S1). Higher discs have the disadvantage of being obstructed by other organs, which would make the technique more complicated to perform. In addition, it is also not indicated for spondylolisthesis procedures. Transforaminal Arthrodesis (TLIF): Very similar to Posterior Arthrodesis, Transforaminal Arthrodesis is performed through a single access (only one side of the disc), where the surgical instruments are guided by Digital X-ray, allowing the surgeon to remove the Lamina, move the nerve structures, and thus access and remove the damaged intervertebral disc. After the disc is removed, a spacer is placed between the vertebrae, the space is filled with bone graft, and then the pins, screws and rods that will fix the spine are placed. This approach offers the advantage of less nerve manipulation and the preservation of some spinal ligaments, which are important for maintaining its biomechanics. Lateral Arthrodesis (LLIF): This is usually performed with the patient lying on their side on the surgical table. Access is made from the side of the body, anterior to the Psoas muscle, and the surgical instruments are guided by digital X-ray. With the instruments positioned on the side of the spinal column, the damaged Intervertebral Disc is removed, the bone is scraped from the vertebrae and a spacer is placed between them, which solidifies over time. This is a technique that can be performed for some higher disc degenerations, such as T12-L1, up to L4-L5. It cannot be performed on L5-S1 (which is the most common cause), because of the pelvic bone. The technique to be chosen is the responsibility of the surgeon, who must evaluate the level of disc degeneration, the height of the disc, whether or not the disc suffers from Spondylolisthesis, and the surgeon's familiarity with the technique. You may be interested in: Treatments for Lumbar Disc Herniation. • Treatments for Lumbar Disc Herniation... Blocking for Cervical Disc Herniation. • Blocking for Cervical Disc Herniation... Follow us on Instagram: /drandremansano Visit our website: http://www.drandremansano.com.br/ Appointment scheduling: WhatsApp: 11971175715 Or via the link: https://agendar.amplimed.com.br/andre... Important: before starting any treatment, seek medical evaluation. Dr. André Mansano - Specialist in Pain Treatment. São Paulo - SP. __ #lumbarspine #discherniation #backpain