Anterior Lumbar Spine Fusion Surgery

Types:

Posterior Lumbar Interbody Fusion (PLIF):

• Procedure: Bone grafts and small wedges, assisted by screws, are placed between the vertebral bodies from the spine’s back.
• Recovery: Hospital stay can extend to six to eight nights.

Anterior Lumbar Interbody Fusion (ALIF):

• Procedure: The bone graft, often aided by a wedge, is placed between vertebral bodies from the spine’s front. A vascular surgeon may assist due to the proximity to major blood vessels.
• Recovery: Patients usually stay three to four nights in the hospital.
• Advantage: ALIF generally causes less postoperative pain compared to posterior surgery, as no muscles are cut, just separated.

Objectives:

The primary goal is to eliminate back pain and any related symptoms by solidifying the space between the vertebrae using a bone graft, possibly combined with implants like screws, small plates, rods, or wedges to maintain stability during the healing phase.

Considerations for Younger Patients:

Young patients may opt for artificial disc replacement instead of a fusion to preserve mobility and flexibility in the spine.

Surgical Approaches:

Anterior Approach:

• Incision: Horizontal, approximately 4 – 5 cm long, between the stomach and the pubic area.
• Outcome: Lesser pain post-surgery compared to the posterior approach as muscles are separated, not cut.
• Limitation: It’s predominantly used to treat back pain; access to nerve roots is more challenging.

Posterior Approach:

• Outcome: It may involve more pain due to muscles being peeled off the bone, even in minimally invasive procedures.

Potential Complications:

• Vascular Injury: Major blood vessels located in front of the lumbar spine may be at risk; hence, a vascular surgeon often assists in ALIF.
• Retrograde Ejaculation (Males): A rare condition that may affect conception but usually resolves over time.
• Sympathectomy: Rare and generally affects patients with extensive mid-lumbar dissection, potentially causing a warm and dry leg and excessive sweating.

Lumbar Fusion Surgery is a valuable solution for persistent lumbar spine issues, with the choice of approach and method being contingent on individual patient conditions, age, and the specific challenges posed by the affected vertebrae. The potential benefits are considerable, but an awareness of potential complications and a thorough discussion with the neurosurgeon like Dr BSV Raju is crucial for optimal outcomes.

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