LOW BACK PAIN

Minimally Invasive Lower Back Surgery for Disc Degeneration: The Side Approach

Spinal Fusion

Spinal fusion is a surgical treatment option for conditions such as degenerative disc disease. The objective of the procedure is to stabilize and immobilize the joint between two vertebrae, which will alleviate pain and improve back function. In an interbody fusion, the damaged intervertebral disc is replaced with a specially designed cage that maintains proper alignment of the spine and restores proper disc height. 

Realigning the spine and restoring disc height enlarges the space through which nerves exit. Furthermore, these cages contain harvested bone and growth factors that will stimulate the vertebrae to grow together, or fuse.

Traditional Techniques

There are several traditional approaches to access the spine for an interbody fusion. A posterior approach (from the back) provides direct access to the spine but involves disrupting major back muscles and manipulating nerves that can lead to pain and loss of sensation after the surgery.

A traditional anterior approach (from the front) provides excellent access to the spine, and from this approach surgeons can restore collapsed disc spaces, release and correct spinal deformities such as scoliosis, and ultimately help patients achieve solid fusions. Accessing the front of the spine through a traditional anterior approach spares the back muscles and nerves but involves large incisions and requires careful manipulation of the major blood vessels and organs of the abdomen.

Lateral Approach

A more recently developed lateral approach (from the side) may also be used and offers several advantages over the traditional approaches while maintaining the benefits of an anterior exposure of the spine. In this minimally invasive technique, the patient is positioned on his or her side.

The surgeon will identify the affected disc using x-ray and mark the appropriate position for a small, lateral incision. Through this incision, the psoas muscle is the only muscle that will need to be transversed.

Neurologic monitoring devices are used to dissect through the psoas muscle, lowering the risk of nerve injury. Once the disc space is exposed, the surgeon meticulously releases the deforming forces of the spine and prepares the bones for fusion. The damaged disc is removed and the specialized cage is implanted.

These far lateral techniques to access the spine may be combined with posterior approaches to obtain complete reconstruction of the spine. Alternatively, the anterior approach from a far lateral technique may be done as a stand-alone procedure for certain patients.

Benefits of the Lateral Approach

One benefit of the lateral approach is that incisions made in this position can be significantly smaller than incisions of the traditional approaches. In addition, approaching the spine from a lateral incision avoids many of the vital organs, muscles, and vessels that may be disrupted by the traditional approaches, decreasing the likelihood of post-operative abdominal muscle weakness and hernias.

As a result, patients who undergo surgery using this far lateral approach to the lumbar spine commonly experience less blood loss and tissue trauma, improved mobilization, and faster recovery times.