This is a minimally invasive technique of doing anterior interbody fusion of lumbar spine from L1 to L5. L5 S1 fusion cannot be done due to the fact that the iliac crest is in the way. The approach could be extended to include the thoracic spine. For more detailed information and video animation of the surgery please check out the website www.lateralaccess.org.
The approach is done through a small about one inch or so incision in the flank or side of the abdomen. Blunt wand is introduced behind the abdominal cavity through the psoas muscle to dock onto the lateral aspect of the lumbar disc spaces. During the approach electronic monitoring is performed to make sure that nerves in the psoas muscle are out of the harms way. Intraoperative x ray called fluroscopy is essential to guide the wand to the correct spot at the side of the disc space. Once it is positioned in good location a pin is inserted through the wand into the disc space and series of dilators are used to enlarge the access portal. Finally extremely well designed self retaining long retractor with fiberoptic light is inserted and secured into a rigid position and all subsequent work is done through the portal established by the retractor.
Disc material is then removed and is replaced by either titanium or absorbable cage packed with either patient's own bone or synthetic bone graft material. After that either a side plate may be applied or patient can be repositioned to apply posterior fixation and/or posterior bone graft.
There is very little blood loss from the procedure. The recovery is quite rapid especially if the side plate is used without the posterior procedure.
Complications include thigh pain related to penetration through the psoas muscle at times associated with numbness. The discomfort usually is temporary but at times can be long lasting or permanent. Other complications include uncontrollable bleeding, risk of neurological injury, infection, and risk of fusion not healing requiring subsequent surgery. In general surgery is very well tolerated by patients.