Skip to main content

Anterior Lumbar Spinal Reconstruction

  • Living reference work entry
  • First Online:
Handbook of Spine Technology

Abstract

The anterior lumbar approach for spinal pathology is a powerful method to achieve reconstruction. It enables wide discectomy, restores disc and neuroforaminal height, optimizes sagittal alignment, and affords large cross-sectional area of endplates for spinal implants while avoiding neural retraction and posterior muscular damage. It is arguably underutilized given the need for a considerable volume of training and need for comfort with abdominal anatomy and vascular handling that is required in its safe application. The preparation of a patient and surgical setup as well as common techniques for anterior lumbar surgery are described in this chapter. Knowledge of assessment techniques and handling of vascular structures in their normal, anomalous, and pathological states is critical for safe and efficient performance of the procedure. Equally, recognition of vascular problems and measures to deal with them enables spinal surgeons to safely expand their indications for this technique which is aided through a multidisciplinary approach and collaboration with a vascular surgery service.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  • Barrey C et al. (2011) Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 20(Suppl 5):626–633

    Article  Google Scholar 

  • Chiriano J et al (2009) The role of the vascular surgeon in anterior retroperitoneal spine exposure: preservation of open surgical training. J Vasc Surg 50(1):148–151

    Article  Google Scholar 

  • Cunningham BW et al (2002) The use of interbody cage devices for spinal deformity: a biomechanical perspective. Clin Orthop Relat Res 394:73–83

    Article  Google Scholar 

  • Fraser RD (1982) A wide muscle-splitting approach to the lumbosacral spine. J Bone Joint Surg 64:44–46

    Article  CAS  Google Scholar 

  • Fritzell P, Hägg O, Wessberg P, Nordwall A, Swedish Lumbar Spine Study Group (2001) 2001 Volvo Award Winner in clinical studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976) 26(23):2521–2532. Discussion 2532–2534

    Article  CAS  Google Scholar 

  • Gao SG et al (2011) Biomechanical comparison of lumbar total disc arthroplasty, discectomy, and fusion: effect on adjacent-level disc pressure and facet joint force. J Neurosurg Spine 15(5):507–514. https://doi.org/10.3171/2011.6.SPINE11250

    Article  PubMed  Google Scholar 

  • Gerber M et al (2006) Biomechanical assessment of anterior lumbar interbody fusion with an anterior lumbosacral fixation screw-plate: comparison to stand-alone anterior lumbar interbody fusion and anterior lumbar interbody fusion with pedicle screws in an unstable human cadaver model. Spine (Phila Pa 1976) 31(7):762–768

    Article  Google Scholar 

  • Hamdan AD et al (2008) Vascular injury during anterior exposure of the spine. J Vasc Surg 48(3):650–654. https://doi.org/10.1016/j.jvs.2008.04.028

    Article  PubMed  Google Scholar 

  • Holt RT et al (2003) The efficacy of anterior spine exposure by an orthopedic surgeon. J Spinal Disord Tech 16(5):477–486

    Article  Google Scholar 

  • Hsieh PC et al (2007) Anterior lumbar interbody fusion in comparison with transforaminal lumbarinterbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine 7(4):379–386

    Article  Google Scholar 

  • Ito H et al (1934) A new radical operation for Pott’s disease. J Bone Joint Surg 16B:499–515

    Google Scholar 

  • Jost B et al (1998) Compressive strength of interbody cages in the lumbar spine: the effect of cage shape, posterior instrumentation and bone density. Eur Spine J 7:132–141

    Article  CAS  Google Scholar 

  • Kim CH et al (2017) A change in lumbar sagittal alignment after single-level anterior lumbar interbody fusion for lumbar degenerative spondylolisthesis with normal sagittal balance. Clin Spine Surg 30(7):291–296

    Article  Google Scholar 

  • Labelle H et al (2005) The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine (Phila Pa 1976) 30(6 Suppl):S27–S34

    Article  Google Scholar 

  • Lee Y, Zotti M, Osti O (2016) Operative management of lumbar degenerative disc disease. Asian Spine J 10(4):80

    Article  Google Scholar 

  • Modic MT, Steinberg PM, Ross JS et al (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166(1 Pt 1):193–199

    Article  CAS  Google Scholar 

  • Panjabi MM (1988) Biomechanical evaluation of spinal fixation devices. I. A conceptual framework. Spine 13:1129–1134

    Article  CAS  Google Scholar 

  • Parvizi J et al (2017) Prevention of periprosthetic joint infection: new guidelines. Bone Joint J 99-B(4 Supple B):3–10. https://doi.org/10.1302/0301-620X.99B4.BJJ-2016-1212.R1

    Article  PubMed  CAS  Google Scholar 

  • Pradhan BB et al (2002) Single-level lumbar spine fusion: a comparison of anterior and posterior approaches. J Spinal Disord Tech 15(5):355–361

    Article  Google Scholar 

  • Puvanesarajah V et al (2017) Morbid obesity and lumbar fusion in patients older than 65 years: complications, readmissions, costs, and length of stay. Spine (Phila Pa 1976) 42(2):122–127. https://doi.org/10.1097/BRS.0000000000001692

    Article  Google Scholar 

  • Regan JJ et al (2006) Evaluation of surgical volume and the early experience with lumbar total disc replacement as part of the investigational device exemption study of the Charité Artificial Disc. Spine (Phila Pa 1976) 31(19):2270–2276

    Article  Google Scholar 

  • Roussouly P et al (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 30(3):346–353

    Article  Google Scholar 

  • Roussouly P et al (2011) Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J 20(Suppl 5):609–618. https://doi.org/10.1007/s00586-011-1928-x

    Article  PubMed  PubMed Central  Google Scholar 

  • Ruey-Mo L et al (2008) Mini-open anterior spine surgery for anterior lumbar diseases. Eur Spine J 17(5):691–697

    Article  Google Scholar 

  • Sachinder H et al (2011) Iatrogenic arterial injuries of spine and orthopedic operations. J Vasc Surg 53(2):407–413

    Article  Google Scholar 

  • Scott-Young M et al (2018a) Concurrent use of lumbar total disc arthroplasty and anterior lumbar interbody fusion: the lumbar hybrid procedure for the treatment of multilevel symptomatic degenerative disc disease: a prospective study. Spine (Phila Pa 1976) 43(2):E75–E81

    Article  Google Scholar 

  • Scott-Young M, McEntee L et al (2018b, In press) Combined Aorto-iliac and anterior lumbar spine reconstruction: a case series. Int J Spine Surg 12:328–336

    Article  Google Scholar 

  • Sehgal N (2000) Internal disc disruption and low back pain. Pain Physician J 3(2):143–157

    CAS  Google Scholar 

  • Steffen T, Gagliardi P, Hurrynag P (1998) Optimal implant-endplate interface for interbody spinal fusion devices. Meeting of the European Spine Society, 23–27 June 1998, Innsbruck, p 4

    Google Scholar 

  • Watkins RG III, Watkins RG IV (2015) Surgical approaches to the spine. Springer, New York

    Book  Google Scholar 

  • Watkins RG et al (2014) Sagittal alignment after lumbar interbody fusion: comparing anterior, lateral and transforaminal approaches. J Spinal Disord Tech 27(5):253–256. https://doi.org/10.1097/BSD.0b013e31828a8447

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matthew N. Scott-Young .

Editor information

Editors and Affiliations

Section Editor information

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Scott-Young, M.N., Grosser, D.M., Zotti, M.G.T. (2019). Anterior Lumbar Spinal Reconstruction. In: Cheng, B. (eds) Handbook of Spine Technology. Springer, Cham. https://doi.org/10.1007/978-3-319-33037-2_124-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33037-2_124-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33037-2

  • Online ISBN: 978-3-319-33037-2

  • eBook Packages: Springer Reference Biomedicine and Life SciencesReference Module Biomedical and Life Sciences

Publish with us

Policies and ethics