This minimally invasive procedure is used to approach a damaged or degenerative disc through the side of the abdomen (retroperitoneum). It is useful to allow correction of both sagittal and coronal spine deformities, and can decompress nerve roots in some instances through indirect decompression – where gaining disc height allows the foramen to be enlarged and thus the nerve is decompressed.
Patients typically recover quickly given it is a minimally invasive procedure, with a shortened post operative hospital stay, reduced blood loss and less post-operative pain than traditional techniques. It is particularly useful in revision cases where there is large amounts of scar tissue surrounding the dura and nerve roots.
The procedure can be performed in isolation, or can be used in combination with a posterior approach to place pedicle screws +/- a direct decompression with a laminectomy. The benefits of using this minimally invasive technique are:
The procedure is performed under general anaesthetic, you will be lying on your side and an xray is used to check the level for the incision. Once the incision is made the abdominal wall muscles are split, the retroperitoneum is entered and specialised retractors are placed to allow for safe access to the affected disc so that it can be removed.
A cage is then trialled to determine the correct size, and an appropriate cage is filled with bone graft and placed into the disc space under xray guidance. A plate and screws can be added for extra stability in some circumstances. The wound is then closed and dressings applied.
You will then be taken to the recovery room and monitored. Once you are safe you will be transferred to the surgical ward. You will be given a light diet until your bowel sounds have returned.
You will be seen by a physiotherapist the following day and begin mobilising. You will not be allowed to lift heavy objects or bend your back to pick up objects from the ground for 6 weeks. Dr Anderson will discuss this with you during your consultation and you will be shown safe ways to perform these tasks while in the hospital. Once safe for discharge from hospital, you will either go home or to an inpatient rehabilitation facility, depending on the advice of the team looking after you. You will not be allowed to drive for 6 weeks.
While generally safe and well tolerated, there are risks with any surgical procedure, such as infection, bleeding and post operative medical complications (heart attack, stroke, blood clots).
Risks particular to this procedure include damage to structures within or close to the posterior abdominal space (retroperitoneum), including:
Despite taking care to avoid these complications, there are still occasions where this can occur. Dr Anderson will take necessary steps to rectify the situation including obtaining assistance from another surgeon if necessary to repair the damaged structure. If the nerves within the psoas muscle are stretched and you have developed pain in the leg, Dr Anderson will often prescribe nerve pain tablets to help treat the symptoms.
Dr Anderson will discuss the risks and benefits of this procedure with you during your consultation. You will be given time to ask any questions you may have.