Anterior Lumbar Fusion
Sometimes we will have to approach the lumbar spine from the front, or anterior aspect. Often, the approach will include the assistance of a vascular surgeon.
Oblique Lumbar Interbody Fusion (OLIF)
This technique doesn’t approach the lumbar spine from the front, but rather from the side.
There is an interval behind the intestines that goes in an area called the retroperitoneum, where there is fat that can be easily dissected through, until we reach a muscle on the side of the spine called the psoas.
If we follow the psoas to the front of the spine, there is another place between the vessels and the front edge of the psoas that can be exploited to safely get to the disc to do the fusion.
The spine can be approached through small incisions on the L side of the abdomen to get to a single or multiple levels.
Below is an example of x-rays after a patient had the OLIF procedure at L2-3 and L3-4 following a previous fusion at L4-5.
Anterior Lumbar Interbody Fusion (ALIF)
In the schematic pictured below, we will approach the spine at L5-S1 between the iliac vessels which are held out of the way by the retractors in this illustration. The small vertical red line is the middle sacral artery that is usually ligated, and we have great exposure to the front of the L5-S1 disc. This exposure can also be used with the access surgeon to get to L4-5 and sometimes also to L3-4.
Below is an example of some xrays of a patient who had an anterior fusion of L5-S1 which healed successfully.