Minimally Invasive Procedure for Lumbar Fusion Surgery

A new minimally invasive approach enables surgeons to perform fusion surgery on the difficult-to-access upper lumbar region of the spine with a reduced risk of serious complications. The new approach was described in the August 1, 2004, issue of Spine.

In other minimally invasive procedures, the preferred approach is from the front or side, but the upper lumbar region is particularly challenging. The most commonly used approach enters through the abdomen and extends through the abdominal cavity. In addition to the risk of small bowel obstruction and the formation of scar tissue in the peritoneum, major blood vessels and sympathetic nerves must be separated or moved out of the way. In men, nerve damage can result in retrograde ejaculation, in which semen escapes into the bladder instead of passing through the urethra.

A lateral approach is sometimes used, but tearing or bruising of the psoas muscle can cause significant pain. The new, more-direct lateral approach actually goes through the psoas muscle, avoiding many of the risks of other approaches to the upper part of the spine. This procedure offers several practical advantages. With patients on their side, gravity draws the abdominal contents out of the way, and the angle at which the spine is approached minimizes the risk of accidental injury to the spinal column during the fusion procedure.

There are other important advantages as well. "Surgical dissection is carried out in a longitudinal fashion in line with the muscle fibers and through the anterior (forward) two-thirds of the psoas muscle. This results in minimal muscular retraction and bleeding, with excellent visualization of the intervertebral disc space,” explained senior author John J. Regan, M.D., co-director of the Cedars Sinai Institute for Spinal Disorders (Los Angeles, CA, USA). The study was based on a review of six endoscopic lateral transpsoas procedures performed by Dr. Regan.




Related Links:
C-S Institute for Spinal Disorders