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The anterior approach to the spine has been around since the 1950s. Originally, the surgery involved a large abdominal incision in which the surgeon would cut through the abdominal muscles and the peritoneal cavity to gain access to the spine. The peritoneal cavity contains the patient’s intestines. This would require long recovery times due to the large dissection of the abdomen and muscles to get access to the spine.
Today, however, the anterior approach to lumbar spine fusion (or other spine surgery, such as the artificial disc) can be done with a minimally invasive anterior approach, involving the following steps:
Once the disc space is exposed, the degenerated disc itself is removed, and disc material that is bulging on the nerve roots can carefully be eliminated. At this point, the disc space can be restored to its native height, which will decompress the nerve roots indirectly in the foramen space, and also help regain any lordosis of the spine. A structural bone graft, cage, total disc replacement, or other device would then be placed into the empty disc space.
As with all surgical procedures, the anterior approach to spine fusion carries with it a few risks and potential complications that are unique to this surgical approach.
The other risks and potential complications associated with the anterior approach to spine surgery are similar problems that one would encounter with a posterior spinal surgery, such as infection, and are not unique to the anterior approach. Infection is very rare. There is an excellent blood supply to the area.
Non-unions can occur, but done properly one should expect a 90-95% fusion rate for patients. Pain relief in patients with degenerative disc disease varies, but it has been reported to be effective for pain relief in between 60% - 90% of patients.
Dr. Goldstein also recommends this overview of Minimally Invasive Spine Surgery
About Dr. Goldstein
Minimally Invasive Surgery
Minimally Invasive Fusion
Theory and MISS
Anterior Approach MISS
Anterior Approach Incision
Lumbar Degenerative Disc
Lumbar Disc Herniation
Dr. Goldstein is recognized as one of the leading spine surgeons in New York. He is a Clinical Professore of Orthopedic Surgery and Neurosurgery at the NYU School of Medicine. His expertise is sought by television, media, and magazines. His practice is focused on surgical treatment:
Dr. Goldstein serves as Director of the Spine Service at NYU Langone Medical Center Hospital for Joint Diseases.
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