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The ILIF Procedure (Interlaminar Lumbar Instrumented Fusion) was developed to overcome the potential shortcomings of standard lumbar spinal stenosis treatments (. decompression alone and decompression with fusion), using a minimally disruptive surgical technique. Lumbar spinal stenosis is a gradual narrowing of the space where nerves pass through the spine, which can be a result of aging and “wear and tear” on the spine from everyday activities and/or resultant positional changes of the vertebrae. The most common surgical treatment for lumbar spinal stenosis is a procedure called a decompression, which involves removing bone or ligaments that are pressing on the spinal cord and/or nerves.
The ILIF procedure involves a minimally disruptive decompression procedure called a laminotomy, which involves temporary distraction (opening up) of the space between the spinous processes, and careful removal of only small sections of bone to release the pressure on the spinal cord and nerves.
Contrast is used to verify epidural location and to indicate the distribution of injectate. Some physicians use contrast as a volume expander while others prefer saline for this use. The contrast is typically nonionic and lowosmolar. In patients with contrast allergies gadolinium can be safely used in most lumbar procedures. 30,31,52,53 If using gadolinium, the amount should be just enough to document epidural injection. Gadolinium should not be used as a substitute for volume expander. The typical amount of contrast or contrastsaline mixture used for either cervical or lumbar interlaminar epidurography is 4 cc to 5 cc (less in nerve blocks; see below). A smaller amount will not provide sufficient contrast for an epidurogram to evaluate for adhesions or distribution of injectate. For coding purposes, an epidurogram is considered to have been performed when approximately 4 cc to 5 cc of contrast is injected regardless of the route (transforaminal or interlaminar). The report, CPT code, and amount billed must be adjusted if an epidurogram is not performed. The amount of contrast injected may be reduced in spinal stenosis. Many patients will feel pressure or leg cramping from almost any volume, no matter how small. Patients undergoing first-time injections may confuse this with pain. Careful questioning and reassurance that pressure is normal will be adequate in most cases. The injectate volume should be reduced if significant pain is experienced.