Your spine surgeon has determined that you need an operation for your back problem and feels that there would be a benefit to approach your spine from the front, through the abdomen. Most people are aware of back operations that are performed from the posterior approach, through the skin of the back, but are surprised when they are told they are going to have a back operation "from the front." The organs in the abdomen actually rest on the spine. With the exception of the large blood vessels (the aorta and vena cava) the remaining organs can be lifted off of the spine, which offers an excellent approach for your surgeon. The blood vessels require greater dissection, but an experienced surgeon can often move them aside with minimal problem.
WHY GO THROUGH MY FRONT (ANTERIOR APPROACH) TO GET TO MY BACK?
Your doctor has selected an anterior (front) approach to your spine rather than the posterior (back) approach. A part of your operation requires the removal of a badly degenerated disc as well as performing a fusion or bond between two vertebral bodies, or to place a new artifical disc. The disc is a cushion or pad between the bones (vertebral bodies) of the spine. An "interbody fusion" is a bony bridge that "welds" the two vertebral bodies together to stop unstable motion. It is this unstable motion that may be partially responsible for your back pain. The disc is actually located on the front part of the spine. Approaching the disc from the front avoids the need to move the spinal nerves and spinal cord out of the way to get to the disc from the posterior or back side. Surgery on the disc space from a posterior approach may cause long term pain due to:
- Manipulation and retraction of the nerve roots which can injure or damage the nerves.
- Bleeding around the nerve roots which can produce scar tissue that can lead to pressure on the nerve.
ARE THERE OTHER ADVANTAGES TO THE ANTERIOR APPROACH?
- Inter-vertebral disc height (the space between the two vertebral bodies is left after the disc is removed) may be better restored with the anterior approach. Restoring this space opens up the neural foramen (the openings in the spine that allow the nerves to leave the spinal cord) taking pressure off of the nerve roots.
- Removal of bone from the spine (which is necessary from the posterior approach and can be destabilizing) is not necessary.
- The normal anatomy of the spine is preserved since the frontal approach takes advantage of normal tissue planes and does not require removal of any bone.
WHY DO I NEED ANOTHER SURGEON WHO IS NOT A SPINE SURGEON?
Whereas your spine surgeon has the expertise to diagnose and treat your spine problem, the general surgeon has the expertise to approach the spine using minimal invasive techniques. By combining the expertise of both surgeons, your surgical team can afford to offer you the best chance at a safe and efficient operation. The co-surgeon is a general surgeon who:
- Is accustomed to working with structures such as major blood vessels and intestines that are in front of the spine.
- Can assist the spine surgeon with some parts of the operation
- Is present during your operation to both assist the spine surgeon and protect the vital structures in the vicinity where the spine surgeon is working.
WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED OR COMPLETED BY THE ANTERIOR APPROACH?
In a small number of patients the anterior approach does not work effectively. Factors that may increase the possibility of choosing a lateral or posterior approache may include:
- Obesity, with a bmi (body mass index) of 30 or greater, is our cut-off for safe spine exposure. Please click on Patient Education at the top of this page to find a BMI Calculator. If you need to lose weight, you might consider the Medifast program. A link is found on our Helpful Links page.
- A history of prior abdominal surgery causing dense scar tissue
- Inability to visualize structures.
- Unusual bleeding during the operation.
- Please note that smoking prevents proper healing of spine surgery. A continuing smoking habit will eliminate you from having any spine surgery. You must have quit tobacco at least one month before we can schedule surgery. The Washington State Department of Health offers a helpful stop smoking line at 1-800-784-8669.
The decision to perform any procedure is a judgment decision made by your surgeon. The decision to recommend an alternative procedure is based primarially on patient safety.
WHAT SHOULD I EXPECT AFTER SURGERY?
After the operation it is important to follow your doctor's instructions. Remember, your body needs time to heal. You should check with your spine surgeon and co-surgeon about scheduling a follow up appointment, diet and what type of activity you should engage in.
WHAT COMPLICATIONS CAN OCCUR?
These are major surgeries, and serious complications such as heart attack, stroke and even death are rare but possible. Most of those risks are related to the general anesthesia and being put to sleep. Complications specific to the spine surgery are related to blood vessels, small nerves and other structures that lie in front of the spine and are at risk of being injured. Injuries to the intestine, ureter and urinary bladder may occur. Infection of the incisions or to the spine is rare, but can occur. With any operation, blood clots can form in the legs and may even spread to the lungs causing lung problems. Working near large blood vessel in front of the spine and needing to move these blood vessels aside makes these complications more likely. The occurrence of any of these complications may require additional surgical or non-surgical treatment.
Retrograde ejaculation is reported to occur in 2-4% of men who undergo the anterior approach to the spine. This rare complication is due to disturbing the small sympathetic nerves that control normal ejaculation. With retrograde ejaculation, erection and ejaculation do occur, but the sperm and semen is discharged into the urinary bladder rather than going out the penis. In women, these same nerves control vaginal lubrication. Men who are considering anterior spine surgery but have not finished building a family, may wish to consider donating sperm for storage in a sperm bank prior to their operation.
Your surgeons will take every effort to minimize the occurrence of any of these complications.