Low back pain is one of the most common symptoms addressed in primary care clinics, and most cases are acute with no clearly identifiable underlying cause. While most people recover, recurrence is common, and the condition can become chronic and disabling for some.¹ Patients who have exhausted all conservative treatments or non-invasive options may be candidates for surgery.
 
Unlike traditional spine surgery where the spine is accessed from the front (anterior) or the back (posterior), recent technological advances now allow surgeons to approach the spine from the patient’s side, which is called lateral access spine surgery. This minimally invasive method is performed through a small incision on the lateral flank of the patient. It has been proven to limit bleeding, scarring, and reduce procedure and recovery times, as it does not require dissecting through back muscles, bones, or ligaments.
 
Meeting Surgeons’ Needs
One of the challenges spinal surgeons continue to face is finding the right surgical tools that maximize performance while minimizing damage to a patient’s surrounding tissues. As a surgeon who routinely performs lateral access spine surgery, having the appropriate tools is a key part of a successful procedure and positive outcome.
 
While there are many options available on the market for accessing the spine laterally, I was drawn to Stryker’s system—Niagara, because it offered a unique solution for my surgical needs.
 
With Niagara, I can drop the stabilization shim while the dilators are in place, enhancing the stability and precision of my placement while minimizing the need to adjust or reposition throughout the procedure. The system also allows independent movement of all three blades, giving me full control regardless of the anatomical challenges I encounter and ensuring the safety of my patients. I believe it is one of the most adaptable retractors on the market.
 
When I think about what sets this retractor system apart from other systems, it is the radiolucent PEEK-infused carbon fiber components, which allow for better visualization of pathology without having to reposition the C-arm. This not only provides me with a clear view for initial placement, but also reduces the number of fluoroscopy shots I need to confirm implant location and placement. The system’s integrated illumination feature further enhances my ability to visualize the operative site, and dedicated mounting, lighting, and shim options allow for customized assembly and set-up.
 
I cannot emphasize enough the value of having a retractor that easily adjusts to both my technique and my patients’ anatomy. Niagara is well designed for all types of lateral lumbar spinal surgery—straightforward or complex—and comes with a complete set of disc prep instrumentation as well as a range of 3D-printed Cascadia Lateral porous titanium implants. It truly provides all the options that I may need during a surgery.
 
Focus on Patients’ Recovery and Quality of Life
As a surgeon, I perform four to six levels of lateral surgeries every month in addition to posterior and anterior lumbar fusions. Going into a surgery, it is reassuring to have access to a comprehensive portfolio, and as a result, my work is streamlined.
 
When a patient walks into my clinic, he or she typically has a very low quality of life and is suffering from acute or chronic back pain. If surgery is the best option to address his/her condition, my job is to focus on the individual’s specific anatomy and tailor fit my surgical approach to the patient’s needs. Having the right tools helps to ensure the best possible outcome. As surgeons, our goal is to help those with debilitating back pain improve their quality of life and get back to the activities they love.
 
Reference:
¹ Treatment of Low Back Pain. Wegner HC et al. JAMA. 2017 Aug 22;318(8):743-744.

Dr. Salari is a board-certified, fellowship-trained orthopedic spine surgeon with specialized training in the operative and non-operative treatment of pathologic conditions affecting the spine. His expertise in minimally invasive, tissue-sparing approaches allows for the fastest recovery times and minimizes postoperative pain. Dr. Salari is also a member of various professional organizations, including the North American Spine Society and the American Academy of Orthopaedic Surgeons.