This document discusses minimally invasive surgical treatment options for back and leg pain caused by degenerative spine conditions. It describes Dean E. Smith MD's practice specializing in minimally invasive spinal surgeries using techniques like eXtreme Lateral Interbody Fusion (XLIF) that provide benefits over traditional open surgeries such as reduced post-op pain, shorter hospital stays, and faster recovery times. Common indications for these procedures, including degenerative disc disease, spondylolisthesis, and degenerative scoliosis, are outlined along with how XLIF can help alleviate symptoms by restoring disc height and spinal alignment.

2. Suffering from Back or Leg Pain?
Minimally Invasive
Treatment Options for Degenerative
Spine Conditions
El Paso Spine Center
Dean E. Smith MD

3. Foundation Hospital

4. Dean E. Smith MD
Spine Center
• Board Certified
• Fellowship Trained
• Spine Surgeon
• Practicing in El Paso Texas Since
1992
• Minimally Invasive Spinal Surgeries
• Major reconstructive Spinal Surgeries
• Cervical Spine
• Thoracic Spine
• Lumbar Spine

5. Minimally Invasive Surgery
Minimize Collateral Damage to
normal tissue
Typical Incision
One level Lumbar Fusion

6. About Back and Leg Pain
• An estimated 10 million adults suffer
from chronic back pain annually.
• Back pain is the #1 cause of healthcare
expenditures in the U.S.
– Direct cost of over $50 billion
for diagnosis, treatment, and
rehabilitation

7. Back Pain Symptoms
• Acute pain
• Chronic pain
• Back pain can be felt constantly or
intermittently and may be a dull ache or
a sharp, piercing, or burning sensation.
• The pain can stay in one place or refer
or radiate to other areas, such as the
front, side, back, legs, and neck.

8. Back Pain Causes
• Muscles
– Sudden, awkward movement,
strained back muscles and
ligaments, lifting heavy
objects, or using improper
form when lifting objects
• Nerves
– Pressure or impingement of
nerve roots in the spinal canal
can be caused by:
• Herniated discs
• Collapsed disc spaces
• Arthritic conditions
• Bone spurs
• Displacement of vertebrae

9. Back Pain Prevention
• Body Position
– Lifting
– Sitting
– Sleeping
– Standing
• Exercise
– Aerobics
– Stretching
• Other Considerations
– Smoking
– Weight

10. Non-Surgical Treatment Options
• Heat
• Medications
• Exercise
• Acupuncture

11. Surgical Treatment Options
• Once all non-surgical treatments have
been exhausted, surgery may be the
next step.
• “Symptoms and indications for back
pain have not changed, but surgical
treatment options have.”
• Spinal surgery treatment options are
defined by the “approach,” or the way in
which the surgeon accesses the spine.
• Each option has its own set of risks
and benefits.

12. Traditional Surgical Approaches
BackFront Back

13. Surgical Approach
XLif TLif ALif PLif
• eXtreme Lateral Interbody Fusion (XLIF)
• Advantages:
– Does not require entry through sensitive
back muscles, bones, or ligaments or the
retraction of major blood vessels
anteriorly
– Made safe with the use of nerve
monitoring technology
Side

14. Lateral Interbody Approach
XLif
Side

15. A Minimally Disruptive
Surgical Approach

16. Surgical Incision

17. Minimally Invasive Lumbar

18. Minimally Invasive Lumbar

19. Minimally Invasive Robot Lumbar

20. Surgical Approaches

21. NeuroVision
®
JJB
• Advanced technology that provides
intraoperative information
about nerve safety
• Used successfully in over 100,000
spinal surgeries

22. Laser Spinal Surgery
*
*

23. • Only FDA-approved
mechanical guidance system
for spinal surgery
• Over over 5,000 procedures
performed
• Available in only 63 sites
worldwide
• Reduce fluoroscopy/risk
• High confidence and Safety in
difficult surgeries
Mazor Robotics Renaissance™

24. Patient Benefits
Minimally Invasive Surgery
Source:
*Wright N, XLIF – the United States experience 2003-4, International Meeting on Advanced Spine Techniques, 2005, Banff, Canada.
*
*
*
*

25. Benefits
• Reduced post-op pain
• Shorter hospital stays
• Faster recovery
Rapid
return to
normal
activity
Minimally
Invasive
Procedure
• Less tissue disruption
• Minimal blood loss
• Nerve safety (NeuroVision
®
)

26. Lumbar Anatomy

27. Indication
Degenerative Disc Disease (DDD)

28. Indication
Degenerative Disc Disease (DDD)
• Symptoms
– Pain in the back, buttocks,
or leg
• XLIF Correction
– Reduces motion between
the vertebrae
– Corrects alignment
– Restores proper disc height
– Alleviates pain
Disc Degeneration
before XLIF
Restoration of Height
after XLIF

29. Indication
Degenerative Disc Disease (DDD)
• Symptoms
– Pain in the back, buttocks,
or leg
• XLIF Correction
– Reduces motion between
the vertebrae
– Corrects alignment
– Restores proper disc height
– Alleviates pain
Disc Degeneration
before XLIF
Restoration of Height
after XLIF

30. Degenerative Disc Disease
Case Study
- x-rays
(AP and lateral)
- MRI if relevant

31. Degenerative Disc Disease
Case Study
- x-rays
(AP and lateral)
- MRI if relevant

32. Surgical Incision

33. Indication
Spondylolisthesis

34. Indication
Spondylolisthesis
• Symptoms
– Impingement of nerves and
fatigue of back muscles
• XLIF Correction
– Reduces motion between
vertebrae, corrects alignment,
and restores disc height Spondylolisthesis
(Malalignment)
before XLIF
Restoration of Alignment
and Disc Height after XLIF

35. Open Spinal Surgery

36. Open Spinal Surgery

37. Spondylolisthesis
Case Study
- Intra-op fluoro or photos,
if available
- keep to a minimum,
fitting on this one
slide only

38. Indication
Degenerative Scoliosis
• Symptoms
– Back and/or leg pain due to muscle
fatigue and nerve impingement
• XLIF Correction
– Restores proper alignment and
disc height
Degenerative Scoliosis
before XLIF
Restoration of Alignment
after XLIF

39. Degenerative Scoliosis
Case Study
- x-rays
(AP and lateral)
- MRI if relevant

40. Degenerative Scoliosis
Case Study

41. Case Study
- Intra-op fluoro or photos,
if available
- keep to a minimum,
fitting on this one
slide only

42. STEM CELLS
•Osteocel is an
allograft cellular
bone matrix retaining
native mesenchymal
stem cells (MSCs)
and osteoprogenitor
cells
•provides all 3
components for bone
formation:
1. osteoconductivity:
cancellous scaffold
2. osteoinductivity:
MSC growth factor
3. osteogenicity:
osteoprogenitor cells

43. Nate Quarry, Ultimate Fighter & XLIF
®
Surgical Patient, June 2006 – Returns to
Octagon 15 Months After Surgery

44. Thank You
ElPasoSpine.Center
ElPasoSpineCenter.com
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