Dr. Sherwin Hua has developed and patented the smallest incision and most minimally invasive techniques for spinal fusion. The Dime Spine Fusion technique allows a full fusion called a TLIF (Transforaminal Lumbar Interbody Fusion) or a PLIF (Posterior Lumbar Interbody Fusion) through a single dime or nickel sized incision (18-20mm). Sometimes two dime sized incisions are necessary for more unstable conditions called spondylolisthesis.
As a comparison, typical fusion surgeries may require 7-10 inch incisions (more than 10X the length of a dime). Even when the most common minimally invasive technique is used (Medtronic's Sextant system), 6 dime sized incisions are necessary for a single level fusion. Dr. Sherwin Hua performs the same spinal fusion surgery through only one dime or nickel sized incision (in some patients who need correction of significant spondylolisthesis, 2 dime sized incisions may be required). This is a FULL LUMBAR PEDICLE SCREW FUSION performed through the same or smaller incision as some of the smallest MICRODISCECTOMY incisions!
Smaller incision means less tissue damage, less disruption of adjacent anatomy, faster recovery, faster healing, and lower infection rates. Lastly no laminectomy is typically needed, meaning the ligamentous connections with adjacent levels are preserved. This is the least invasive treatment for spinal stenosis and back pain.
Single Dime Sized Incision TLIF
A newer type of fusion called XLIF or DLIF can be done for lumbar levels above L5 (i.e. L5,S1 cannot be done through this approach and L4,5 can be done in most cases). This approach involves an incision from the side of the body to access the disc space from the side (lateral) so that the disc can be cleaned and removed and the spacer between the vertebrate can be placed. However, these lateral fusions often require a separate incision from the back to place the same screws as a regular fusion from the back of the spine. The incision at the side of the body is usually 1-2 inches (25-50 mm) and the incisions for the screws in the back range from 4 to 6 dime sized incisions.
Lumbar fusions can also be performed through the abdomen, called ALIF or Anterior Lumbar Interbody Fusion and OLIF with the approach between ALIF and XLIF. This approach involves a 3-5 inch incision in the abdomen bypassing the abdominal organs (patients with larger abdominal girth require larger incisions). Additionally the major veins and arteries going to and from the heart lie just in front of the spine in this region and need to be moved in order to access the spine. The major risks include injury to the major blood vessels and abdominal organs including bowels. Because of these risks, a vascular surgeon is typically needed to help access the spine and in case of injury to the blood vessels or abdominal organs.
In contrast, the dime size fusion technique is performed from the back, avoiding the abdominal organs and major vessels. Furthermore, the same small incision is used regardless of the patient's body size. The dime size fusion technique allows the placement of a large interbody spacer and 4 screws all through a single or bilateral dime sized incisions in the lower back. For 2 level fusions such as L4,5 and L5,S1 TLIF, a similar dime sized incision on each side is used for 2 interbody spacers and 6 pedicle screws. Additionally the dime fusion technique is perfect for the lower lumbar levels L4 to L5 and L5 to S1, whereas the XLIF and DLIF cannot be performed in the lower lumbar levels because the hip obstructs the lateral approach at these levels.
If you have been told you need a spinal fusion (ALIF, TLIF, PLIF, Axialif, XLIF, DLIF), you should seek a second opinion to see if there are alternatives and if you qualify for a Dime Spine Fusion.
Xtreme Lateral Interbody Fusion (also DLIF) involves placement of a large interbody spacer through the lateral approach. The hips prevents XLIF from accessing the L5S1 level. Typically XLIF also requires posterior pedicle screw placement through 2-4 more incisions.
At DimeSpine, 1-2 small dime sized incisions are all that's needed