Patient Information for Laparoscopic Spine Surgery from SAGES

Introduction

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 spine (or back bone) can be reached from the front. Although back operations from an anterior or front approach have been around for decades, they have usually be used for the more difficult and complex spine problems due to the need for a large abdominal incision. With the introduction of minimal invasive surgery (also known as laparoscopy), your surgeons can now perform a spine operation from the front without having to make a big incision. Your spine surgeon has recommended one of these minimally invasive techniques for you. This minimal invasive technique is called “Laparoscopic Anterior Spine Surgery.” The laparoscopic approach uses small puncture holes instead of long incisions. A special lighted telescope is inserted through one of these puncture holes projecting a picture on a television screen allowing your surgeon to see the spine. Additional puncture holes are used to allow other specialize surgical instruments into your abdomen to perform the operation. This brochure has been designed to help you better understand your laparoscopic spine surgery.

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 attempting to get a fusion or bond between two vertebral bodies. 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 is felt to 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 the spine is preserved since the frontal approach takes advantage of normal tissue planes and does not require removal of any bone.

WHAT ARE THE ADVANTAGES OF THE LAPAROSCOPIC (MINIMALLY INVASIVE) APPROACH?

The advantages of the minimally invasive or laparoscopic technique are:

  • Small incisions and little blood loss
  • Less post-operative pain and need for pain medication
  • Earlier discharge from the hospital
  • Shorter post-operative disability at home

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 laparoscopic surgeon has the expertise to approach the spine using minimally 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 laparoscopic operation. The co-surgeon is a general surgeon known also as a laparoscopic surgeon who:

  • Is accustomed to working with non-bony 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, such as obtaining bone for the bone grafts.
  • 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.

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Brought to you by:

SOCIETY OF AMERICAN GASTROINTESTINAL ENDOSCOPIC SURGEONS (SAGES)
11300 West Olympic Blvd., Suite 600
Los Angeles, CA 90064
Tel:
(310) 437-0544
Fax:
(310) 437-0585
E-Mail:
publications@sages.org
This brochure is intended to provide a general overview of a surgery. It is not intended to serve as a substitute for professional medical care or a discussion between you and your surgeon about the need for a surgery. Specific recommendations may vary among health care professionals. If you have a question about your need for a surgery, your alternatives, billing or insurance coverage, or your surgeons training and experience, do not hesitate to ask your surgeon or his/her office staff about it. If you have questions about the operation or subsequent follow up, discuss them with your surgeon before or after the operation.