Dr McCombe is an . He has a special interest in disc replacement surgery in the lumbar (low back) spine and cervical (neck) spine as well as in disorders of spinal posture (sagittal imbalance). He is also interested in cases of deformity causing nerve compression such as spondylolisthesis and degenerative adult scoliosis. He inserted the first cervical disc replacement in Australia in 2000. He has an interest in spinal implant design and, in conjunction with a neurosurgical colleague, has designed two implant systems used for posterior lumbar interbody fusion (R90 and Capstone Contol). He conducts clinical research into patient outcomes and theoretical mathematical analysis of spinal balance.
AXIALIF - An AXIALIF (Axial Lumbar Interbody Fusion) is a procedure to perform an interbody fusion at the bottom of the spine by placing the instruments below the sacrum and coccyx, getting to the front of the spine through a small incision behind the bottom of the spine.
Lumbar fusion surgery is a procedure performed to immobilize two adjacent vertebrae or a number of vertebrae in the lower back part of the spine. It may be performed to relieve back pain, stabilize the spine, or to restore a more normal shape to the spine.
Grade 1 spondylolisthesis, or a slipped disc, is a spinal condition that can be very painful. When one vertebra slips forward over the other, the result is uncomfortable friction exacerbated by motion. While pain is sometimes confined to the area of slippage, a slipped disc can also put pressure on adjacent nerve roots, causing numbness, tingling, and/or weakness in the extremities.
Spondylolisthesis is the word that spine surgeons use to describe the displacement of one on top of another. It can be caused by aging or repeated microtrauma and has a wide range of symptoms from none at all to pain and nerve symptoms. This confusing word is pronounced "spon-dih-low-lis-thee-sis".
The symptoms of spondylolisthesis can be wide-ranging from an incidental finding on X-ray (no symptoms) to severe back and leg pain with nerve damage. Many cases of spondylolisthesis in children cause few symptoms. Intermittent back pain may be found, especially when arching the back.
During other situations, the surgeon may remove a significant amount of bone in order to adequately decompress nerve roots. While this extensive removal of bone will decompress the nerves and relieve pain to the legs, it may at the same time cause instability of the spine. In this case the surgeon will perform a fusion to re-stabilize the spine.
How is Grade 1 Spondylolisthesis Diagnosed and Treated?
The best way to confirm a diagnosis of grade 1 spondylolisthesis is through MRI and CT scans. These images allow your doctor to see the exact position of the slipped disc and the degree of slippage so far. Physical therapy is usually the first step toward managing symptoms of grade 1 spondylolisthesis. However, if this method fails to control pain, surgical treatment may be the best option.
Grade 1 spondylolisthesis can happen as the result of injury at any age, but it usually arises gradually in older adults. As the spinal discs undergo wear and tear, they may become dried out and compressed. This compression of the spine can cause the vertebrae to overlap one another, while the disc itself may protrude into the spinal canal, pinching nerves.
PLIF, & TLIF – Both the PLIF (Posterior Lumbar Interbody Fusion) or TLIF (Transforaminal Lumbar Interbody Fusion) are performed on the back of the spine. The patient will be turned on to their stomach in the operating room in an extremely careful manner to protect all pressure points. The incision is performed in the midline.
When performed from the back, the fusion materials may be placed on both sides of the spine (PLIF) or placed diagonally across the spine from one side (TLIF). A structural support is often placed within the interspace.
Regardless of which type of interbody fusion is performed, screws are often used in the back of the spine to help provide rigidity while the bone fuses and grows. These screws may go through the pedicles and are known as pedicle screws. They may also go through the facet joints in which case they are called facet screws. Screws can be placed into the spine using either an open technique or a minimally invasive technique which may be performed through small incisions in the skin.
Spinal fusion may be performed to relieve back pain, provide stability to the spine or to return the spine to its normal curve. When a patient is experiencing significant pain in the back, a fusion may be performed if it is determined that the pain is coming from the lumbar level.