Surgeons typically approach the spine from the direction that they are the most comfortable with or based on the patient's anatomy. Either way, the goal is the same: fusion of the vertebrae.
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Some problems can be fixed best from one direction or the other. Some problems can be approached from either direction. Your spine surgeon will discuss the specific risks of either approach and customize the solution that is best for you.
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A particular spine surgeon should have the ability to perform either anterior or posterior spinal surgery. Any surgeon who is incapable of either approach should be questioned as to why. Each approach has advantages and disadvantages. If the patient requires a nerve decompression for a diagnosis of a herniated disc or stenosis, this needs to be accomplished through a posterior approach. At that point, the surgeon would perform the nerve decompression and then proceed with a posterior approach for the spinal fusion. The anterior approach has the advantage of less muscle dissection with generally less blood loss and postoperative pain. The disadvantage is its inability to provide access to the nerves for a nerve decompression. Each patient's individual pathology should be evaluated and then the appropriate surgical approach utilized.
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Spinal disease can usually be surgically treated from either the front or back of the spine, and sometimes both. There are advantages to each approach, depending on the condition. In our practice, we have noted less pain and more satisfaction in patients who do not require a surgical approach through the flank or side.
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All spine surgeons are familiar with surgery done from the back. Some surgeons also have experience with surgery done from the front. Usually, it is the specific situation rather than the experience of the surgeon that determines whether a surgery from the back or front is appropriate. Some problems demand one approach or the other or even both. Your spine specialist will determine which approach best suits treating your specific condition. You should question them as to whether or not other options exist for a proposed surgery, and how frequently they perform anterior procedures on the lumbar spine.
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Approaches to the spine are individualized to the specific pathology of the patient. Sometimes that is best approached from the front and sometimes from the back.
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Some surgeons prefer posterior approach and other physicians prefer anterior approach.
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This decision depends on the specific reason that the fusion is being performed, specific issues about the patient (age, gender, previous abdominal surgery, number of levels to be fused, presence of nerve root pressure or not).
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Approaching the spine through the abdomen allows for a more complete discectomy or removal of a disc. Some surgeons feel this improves the results of the fusion compared to fusing through the back only. You should discuss with your spinal surgeon what procedure is best for you.
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Approaching from the front of the spine typically involves a general surgeon. By approaching from the front you are accepting a vascular risk vs. a neurologic risk when approaching from the back. Either way, the best route to the spine is the route the surgeon is the most comfortable with.
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There are many variables, including a surgeon's experience and capabilities, disease process, body habitus, spinal location, risk factors, prior surgery, etc. Each approach has advantages and disadvantages. At this time, there is no evidence that one approach is superior to the other. Each case should be individualized.
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A lot of the approaches to the spine are dependent on the surgeon; some doctors are very familiar with all of the anatomic structures from behind while others are more comfortable approaching the spine from the front first and then doing some less invasive surgery from behind. Sometimes it is a matter of finding the right surgeon to help out, meaning that you may want to approach the spine from the front but if you don't have a good co-surgeon who can help you out with that approach, then maybe the best thing for the patient is just to go from behind. Sometimes if you have scar tissue from a previous spine surgery you may want to avoid that scar tissue by going through the front. On the other hand if you have had spine surgery in the abdomen before you may not be able to go through the front.
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A lot of that has to do with the patient's symptoms. If the patient is complaining of a radiculopathy or a pinched nerve where they have pain from the spine and into the legs and has an associated neurological deficit: if they have weakness in one of their legs if they have a loss of sensation, if they have a change in their reflexes, those patients need a nerve root compression. That can be most commonly and most easily performed from the back. Fusions can be achieved either from the front or the back, so a lot of it depends on the patient's radiographic findings and their symptoms.
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When a surgeon decides to advise surgery for a spinal problem, surgical options should be considered and discussed with the patient. One of many options to be considered by a surgeon contemplating a spinal operation is whether it is best approached from the front or the back. Some operations may even require staged approaches from both sides. Each procedure has its risks and benefits, as well as its advantages and disadvantages. You surgeon should discuss with you his or her opinion as to the best way to approach your problem.
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Surgeons usually approach the spine from the back for posterior-related issues. Some surgeons will approach the spine from the front for issues in which they are trying to get to the disc, which is more easily and thoroughly accomplished through an anterior or front approach.
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It is a matter of what approach they feel comfortable with, what their experience has been with different procedures. Generally, approaches to the abdomen are performed less than approaches from the back.
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Most fellowship trained spine surgeons are comfortable with approaching the spine from either the abdomen or the back. The choice of approach depends on the patient’s specific condition. Each case must be evaluated on an individual basis to determine what approach will offer the greatest chance at success with the lowest risk to the patient. There are advantages and disadvantages to both approaches that must be considered. Sometimes a combined approach is required to provide the best outcome.
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Anterior fusion surgery results in no damage to the posterior spine muscles and is typically more easily tolerated by patients because of this. The anterior procedure is also a quicker surgery in terms of hospitalization and some doctors can even do it laparoscopically. The down side of the anterior fusion surgery is that you can only safely and reliably perform one or two level fusions from the front alone.
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The surgical approach is determined by the physician based on the diagnosis and symptoms of the patient.
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Some problems can be fixed best from one direction or the other. Some problems can be approached from either direction. Your spine surgeon will discuss the specific risks or either approach and tailor make the solution that is best for you.
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There are a number of factors, but no iron-clad rules, that govern the choice of whether to approach the spine from the back or from the abdomen. Depending on the case, one approach may clearly be more beneficial than the other. A physician’s approach to the spine also can be influenced by their own particular expertise or training. Another factor is the patient’s previous surgical history. Going into an area with excessive scar tissue or taking an approach that did not go well during a previous procedure would not make sense. In these instances, a different approach to the spine may be necessary to achieve both nerve decompression and fusion.
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Well it depends on the type of surgery surgeons are trying to do. We can do spine fusions from the front, we can also do them from the back. A lot of it depends on your specific condition. There are some conditions that are best approached from the back and there are others that are best approached from the front.
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Some surgeons are comfortable with exposure of the spine from multiple directions while others are not. Some procedures may be accomplished from multiple directions. Some patients are not candidates for surgery from one direction or the other.
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The approach used to access the spine, anteriorly versus posteriorly, depends on the type of pathology or problems that patient is having. If the problem is in the anterior column of the disc or the vertebral body, most surgeons go ahead and address the spine anteriorly. If the spine has a combination of problems, both anteriorly and posteriorly, some surgeons feel like they have to go posteriorly only. Other surgeons feel that they have to go both anteriorly first, and then posteriorly or vice versa, in order to address the type of problem that the patient is having with his or her spine. Your surgeon will explain to you the risks and complications of each of these approaches and why he or she is choosing one approach over the other.
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