Minimally invasive spinal surgery (MISS) is becoming more popular because the surgery can take less time and the recovery time is faster. Scarring is also minimized. In the past, the anterior approach to performing a discectomy involved cutting through the abdomen. This meant cutting through muscles and navigating the intestines. As horrifying as this sounds, it was performed that way because the anterior approach is the most effective way to access a disc. However, the recovery time was long.
Today, the anterior approach is done with a small incision that is around 3 to 5 inches long. For the lumbar area of the spine, the incision is made around 4 to 5 inches below the navel so that the scar is low enough to be covered with clothing. The abdominal muscles are moved to the side instead of cut, and the peritoneal cavity containing the intestines isn’t infiltrated at all. There are large blood vessels in front of the spine that carry blood to and from the legs. They may be gently retracted in order to access the disc space needing surgery. This entire process makes recovery much easier than it would be otherwise.
Performing the Discectomy
Once the affected disc is exposed, it will be removed. Any disc material that is bulging and touching the nerve roots can be removed. The disc space is then restored to its original height, which will decompress nerve roots and help the spine regain its normal shape. A cage, structural bone graft, or total disc replacement will be performed. Other devices can also be placed inside the empty space to bring structure back to the spine.
Risks of Anterior Discectomy
A number of risks exist when performing a lumbar anterior discectomy. They include:
- Retrograde ejaculation for males, but this is very rare. It happens in less than 1 percent of male patients. When this occurs, it is because of interference with nerves that are located at the lower end of the lumbar spine. A urologist may be needed, but the condition can resolve itself in a few months.
- Blood vessel injury can occur in 1 to 2 percent of cases. A vascular surgeon tends to be involved with the surgery to prevent this from happening. It is very important that the large blood vessels are properly manipulated.
- Infection is always a risk, but it’s not unique to MISS or the anterior approach. Because the blood supply to the area is sufficient, infection hardly ever happens.
- Non-unions can happen, but fusion surgery has a 90 percent to 95 percent fusion rate.
- Pain may not completely relieve, but 60 percent to 90 percent of patients do report pain relief.
Are You a Candidate for MISS?
If you are experiencing back pain that is due to a herniated or bulging disc or because your discs are deteriorating, you may be a candidate for the anterior approach. It is best to consult with your doctor and a qualified back surgeon to determine the best course of action for your specific condition.