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Back in the game: Revoluntionary spine procedure performed at DCH

Contributed | NuVasive Creative Spine Technology With the XLIF procedure, a surgeon gains access to a patient's spine through the side instead of the front. It is a far less invasive process, resulting in a much shorter surgery, less recovery time and less pain.1 / 5
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Contributed | NuVasive Creative Spine Technology3 / 5
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If Dan O'Brien could do it all over again, he would have been in band.

Instead, he was a sports fanatic. He played every sport he could - as often as he could, as hard as he could, as competitively as he could.

It took a toll on his body. He's had one knee replaced and the other one will be replaced in the near future. But it was his back that took the brunt of the injuries. Now 53, the Carlos resident has suffered with severe lower back pain for 25 years.

About eight years ago, he couldn't take it anymore and had his first back surgery to repair a herniated disc.

"That didn't go as planned," O'Brien said of the surgery that was performed in the Twin Cities. "They messed that one up."

A month later he had another surgery, followed by a few more "issues."

It got to the point where, along with the back pain, he had severe leg pain, he couldn't move his left leg, he couldn't walk, get up, sleep, sit or work, and he was constantly taking pain medication.

Two years after his second surgery, a hopeful ray of sunshine appeared in his painful days - Dr. Sunny Kim, an orthopedic spine surgeon at Central Minnesota Spine Center in Alexandria.

Kim performed O'Brien's third major back surgery, and this time he "came out with flying colors," although the recovery was lengthy. O'Brien managed to live the next few years with much less pain and more mobility than after his first two surgeries.

Then last February he decided to take his fish house off the ice - and he fell.

"Three days later it started coming on," O'Brien recalled. "I lost the feeling in my feet and it started moving up into my knees and thighs. I was feeling pain and tingling down my legs. Everything went numb."

Once again, O'Brien resorted to making it through each day in a haze of painkillers. Again, he turned to Kim for help.

This time, Kim had a new procedure that he thought would be the answer - the Extreme Lateral Interbody Fusion (XLIF).

"It is a revolutionary procedure," Kim said, explaining that it is a minimally invasive way of doing spinal fusion in the lumbar and thoracic vertebrae. "It's one of the new paradigm shifts in spine surgery. It can accomplish a lot of things with much less toll on the patient."

In the last three years, Kim has used the XLIF procedure in about 110 of his cases, with much success, less pain and fast recovery time for the patient.

"He recommended this [XLIF]," O'Brien said. "I was in so much pain, they could have said, 'Let's take a gun to your back and shoot' and I would have taken it. I was desperate at that time."

On Thursday, April 8, 2010 O'Brien went under the knife again - this time a much less invasive one - at the Douglas County Hospital in Alexandria, where Kim performs his surgeries. It took only about an hour (typical back surgeries can take eight hours).

When O'Brien woke up, he was amazed.

"It was done, I was pain free," he said. "That night I was sitting up, which is unheard of. I was up walking the next day."

Two days after the surgery, O'Brien walked out of the hospital feeling like a new man. Recovery after his previous surgeries had been "miserable," requiring a week-long hospital stay, months of rehabilitation and the need for constant pain pills. He couldn't even cough or sneeze.

This time it was different, and to O'Brien, it was nothing short of miraculous.

"I never even took any pain pills," he said. "It was unbelievable. My pain was gone. I never thought I would be pain-free."

Not only was the recovery quick and almost painless, O'Brien most likely will not have to have back surgery again.

"Unless I jump off a building and fall flat on my back, it should last me until I die," he said.

"There is less chance of having another back surgery again with this procedure," Kim concurred.

Six months have passed and O'Brien is doing things he never thought he would do again. He's hunting. He's walking. He can sit in a boat and fish. He can golf. He can sit in a car. He can drive and fly. He got a Labrador retriever and is working with her at a game farm. He practices archery.

"I will be able to do whatever I have done my whole life," O'Brien concluded. "Life is good."

About the XLIF

The Extreme Lateral Interbody Fusion (XLIF) is a new approach to spine fusion, in which the spine is accessed from the side of the body instead of the front or the back. By entering through the side, major muscles of the back are avoided and no bone removal is required. This means less postoperative pain and early return to normal function. It can be performed on an outpatient basis.

By avoiding a frontal approach, there is less risk of injury to structures in the abdomen such as the large blood vessels, bowel and the kidney draining tubes. Because there is little muscle dissection, less bone work and smaller incisions, there is less blood loss, less operative time and less pain compared to standard open spine surgery. There is also less risk of nerve injury.

How XLIF works

An X-ray is taken to determine the location of the disc space, the skin is marked to show the site for the incision, and narcotics are injected into the spine.

Two small incisions are made in the side and a probe is inserted through one incision. The second incision is used to help guide surgical instruments. The surgeon uses the probe to stimulate and detect nerves along the spine so it can be avoided and left undamaged.

Dilation tubes are slid over the probe to create a larger opening. Then a retraction device moves aside muscle tissue to gain access to the spine.

The damaged disc is removed and prepared for fusion. A large stabilizing implant is put into the empty disc space, realigning the vertebral bones. This also lifts pressure from pinched nerve roots. A titanium plate is placed over the implant.

Confirmation X-rays are taken and the small incision is closed with a few stitches.

A bone graft will grow through and around the implant, forming a bone bridge that connects the vertebral bodies. This is called a fusion.