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The CemLIF Procedure
Cement Augmentation
Recovery
The CemLIF procedure is a modification to existing anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) procedures. Traditionally both of these procedures require placement of pedicle screws and rods through a separate incision. Instead of screws and rods, CemLIF uses bone cement to stabilize the spacer while natural bone growth takes place.
While most patients who have had a lumbar fusion procedure recommended by a spine surgeon will be a good candidate for CemLIF, the procedure is currently only available for individuals over 60 years of age or with osteopenia. In the future, we plan on using a reabsorbable bone cement in younger individuals, however, additional studies are needed first.
Assuming you meet your insurance/Medicare's criteria for a lumbar fusion, they will generally cover the majority of the surgery (the ALIF or LLIF portion, including the hospital stay and anesthesia). Your costs for this portion are dependent on your insurance benefits, however these costs are usually less than a traditional surgery with rods and screws.
Insurance will not cover the CemLIF portion of the procedure as it involves the "off-label" use of bone cement. This usually costs around $10,000 for a single level fusion.
Depending on your tax circumstances, the IRS may allow for deduction of these costs.
CemLIF is effective for treating conditions like degenerative disc disease, spinal stenosis, spondylolisthesis, lumbar radiculopathy, and recurrent disc herniation, among others. For more information about the conditions which can be treated by CemLIF, see here.
The CemLIF procedure typically takes less time than traditional lumbar fusion due to its streamlined approach. However, the exact duration will depend on the individual case and complexity of the condition. On average, we estimate that the procedure will take approximately 45 minutes per level of spinal repair.
Yes, CemLIF can address multiple levels in the lumbar spine, though this will depend on the patient’s condition and individual needs. Dr. Frenkel will assess whether CemLIF is appropriate for multi-level fusion.
CemLIF-A uses an anterior approach, typically for the L5-S1 level, while CemLIF-L uses a lateral approach for levels above L5-S1. Both approaches utilize cement augmentation but are tailored to provide optimal access and stabilization for specific areas of the lumbar spine.
Polymethyl methacrylate (PMMA) is the traditional bone cement used in the CemLIF procedure. It was first introduced in orthopedic surgery in the 1950s and has been used in hundreds of thousands, if not millions, of procedures since then.
The bone cement used in the CemLIF is an FDA-cleared medical device intended for use in surgeries of the hip, knee, and other joints for the fixation of implants to living bone. The FDA has not cleared it for use with implants in spinal surgeries, but as a licensed physician Dr. Frenkel is permitted by law to use the bone cement “off label” in spinal surgeries.
The published complication rate and risks from the use of bone cement are much lower than from placing screws into someone's spine. Bone cement is used every day by surgeons around the world in various orthopedic surgeries.
In a traditional lumbar fusion with screws and rods, osteopenic or osteoporotic patients often require the use of special cement screws. These screws have holes along the shaft that cement can be injected through to better secure the them in place. We believe that the way bone cement is used in the CemLIF provides similar, if not better, stability.
Cement augmentation stabilizes the spine effectively without screws and rods, creating a secure fusion while reducing postoperative discomfort and the need for additional hardware.
Many patients can resume light activities within a few weeks after surgery, with a gradual return to more strenuous activities as healing progresses. Dr. Frenkel will provide guidance on a safe timeline based on your recovery.
Recovery from CemLIF is typically faster and less painful than traditional fusion surgeries, as the procedure minimizes tissue disruption and avoids large incisions. Many patients experience reduced pain and a quicker return to normal activities. For three months after surgery, it is extremely important that you not engage in strenuous physical activity or otherwise lifting more than 10 pounds or bending or twisting.
The length and ease of recovery is typically dependent on the patient’s age and overall physical health and the complexity of the procedure. A healthy lifestyle will facilitate your recovery. An unhealthy lifestyle, including alcohol, tobacco, and/or an unhealthy diet may prolong your recovery.
In every case, patients must remain in the hospital until their pain is controlled and can meet post-surgical milestones, which typically takes 1-2 days following the surgery but which can take longer if recovery is slower. Some patients may be required to perform in-patient rehabilitation exercises prior to discharge.
