5. ANTERIOR LUMBAR APPROACH : WHEN ?
• Absence of posterior decompression
gestures
• Absence of disc fragment excluded or
having migrated
• Absence of CI (some abdominal
surgeries and obesity)
6. PHYSIOLOGICAL LOGIC
“Minimal Invasive Surgery”
• Respect of the lumbar musculature
( Isolated anterior approach - ALIF )
• Prevents epidural and periradicular
"iatrogenic" fibrosis
21. ANTERIOR LUMBAR INTERBODY SURGERY
Wide and full disc approach
Better possibility of interbody
distraction
Large implant with optimal
contact surface
25. CIRCUMFERENTIAL LUMBAR FUSION
(ALIF + POSTERIOR FUSION)
Female 42 y
Collapsed and inflammatory
disc diseases L2 to L5
Severe foraminous stenosis
L4L5
Important sagittal static
disorder
Considered as a fibromyalgic
patient followed in «Pain
Clinic»
26. CIRCUMFERENTIAL LUMBAR FUSION
Male 64 Y
3 neurosurgical surgeries (Discectomy (2x) +
laminectomy)
Severe spinale stenosis L3L4
Anterolisthesis L3L4 + arthrosynovial cyst
Foraminal stenosis
Loss of physiological lordosis
ALIF L3 S1 +Revision of laminoforaminotomy
& Posterior fusion L3 to S1
Circumferential Fusion L3 to S1
27. ALIF ? TDA ?
ALIF versus TDA ?
... and why not
BOTH !?
28. MOBILE LUMBAR DISC PROSTHESIS
All advantages of anterior lumbar
approach
Preserve or Restore Function
(Mobility)
Limiting constraints on adjacent
segments
33. LUMBAR DISC PROSTHESIS
MOBIDISC LDR ZIMVIE
Male 31 y
Right postero-lateral disc herniation L5S1
Black Disc L4L5
No effect of conservative treatment
34. LUMBAR DISC PROSTHESIS
MOBIDISC LDR ZIMVIE
Male 52 y
Collapsed and inflammatory disc
disease
Disc protrusion
Foraminous stenosis L5S1
Non-conflictual discopathy L4L5
39. ANTERIOR APPROACH
CONCLUSIONS
Advantages :
• Minimal invasive approach
• Minimal blood loss
• Simpler anesthesia (patient in supine position, no support on the
chest or abdomen)
• Preserves the lumbar musculature
• No risk of tearing the dura or injuring a nerve root (no contact with
the nervous elements), no epidural or periradicular fibrosis
• Risk of less nosocomial infection (<0.2% versus 2% for posterior
fusions)
40. ANTERIOR APPROACH
CONCLUSIONS
Contraindications :
• Morbid obesity
• Surgical history (vascular and abdominal
surgery)
• History of infections
• Narrow lumbar channel
Risks :
• Vascular (L4L5)
• Retrograde ejaculation or vaginal dryness
(0.4% in L5S1)
41. If the situation is reasonably
favourable, the Anterior
Approach is my preference
both as first intention and for
revision surgery
www.spinesurgery.be