Which approach to the spine is better and why? Anterior vs. Posterior

[xiaoyu80305]

Two surgeons have different approaches for the fusion of L4-L5 and L5-S1. One will first insert cages from front of the bady, then install instrumentation from back of the body. Second surgeon will do everything from back by 3D imaging system. The surgery time will be 7 hrs vs. 3 hrs. I would like to know which approach is better and why?

Xiaoyu,

[davemmevad]

Hi Xiaoyu,
I get caught up in those details too, so I'll respond to this from 'outside the back' - because the best advise I ever got to this came from a pediatric urologist who treated my son - "Surgery is an art form, the technique is far less important than the outcome." So my question back to you (and the question I always have to remind myself of) is:

Which surgeon is better?

Check their track records, and ask the hard questions. You'll be happy you did.

Cheers,
Dave

[ajj1001]

The probability of achieving a fusion is what is most important. if the anterior and posterior approach has a better rate of achieving fusion then it is best, if the posterior approach works as well or better than that is the easier option on your body. get the facts and figures of previous surgeries using both approaches and see which is better.

[xiaoyu80305]

Hi,

Thanks for both of your advice! You told me what are most important factors that I should consider. Now, I knew what questions should I ask during the consulting visit with the surgeons.

Xiaoyu,

[Gilbert P]

Just a quick question is your surgeon in Loveland CO?

Thanks

Gil

[xiaoyu80305]

Just a quick question is your surgeon in Loveland CO?

Thanks

Gil

One of the surgeons is Dr. Pettine in Lovelend, CO and another is Dr. Choi in Skyridge Medical Center (Denver, CO)

[Justin]

Either approach is appropriate and one may be preferred based on your pathology. Both procedures have pros and cons.

The anterior approach inherently carries more of a risk, as the great vessels (inferior vena cava and abdominal aorta) must be mobilized to expose the higher lumbar levels (L5/S1 occurs just below the bifurcation of the great vessels [or where the great vessels split into the common iliac arteries and veins]). Mobilization means retracting, or moving, the great vessels to the side of the vertebral bodies; thus, exposing the intervertebral discs.

The posterior approach to the spine can often involve a lot of muscle stripping and insult to many posterior stabilizing structures.

I just did a quick search, and this is a great read: Anterior Approach for the Treatment of Lumbar Degenerative Disorders: Axial Back Pain.

[Nairek]

My surgeon did an anterior and posterior approach when he fused L5/S1. I have to agree with Justin's statement that pathology may determine the type of approach.

In my case, my surgeon was more comfortable with inserting the cage through the front and then implanting rods and screws through the back. He felt that by adding the rods and screws it would make the fusion stronger. I wasn't happy about the additional scars but I wasn't about to argue with him!

[KanRunMo]

You don't say your age but I assume you are fairly young (at least under 50). The doctor I talked with said as you get older, your blood vessels get stiff so it is harder to move them with out breaking them. I then would think the posterior approach would be better though he didn't go into that.

[xiaoyu80305]

You don't say your age but I assume you are fairly young (at least under 50). The doctor I talked with said as you get older, your blood vessels get stiff so it is harder to move them with out breaking them. I then would think the posterior approach would be better though he didn't go into that.

I edited my signature. I am 67. Here is the german surgeon's recommendation for fusion:
The choice of fusion cages is wide, but STALIF L or SYNFIX is best in this constellation (choice depending on ind. Anatomy) . We do have several models “on stock”, incl. Pyramid-shaped plates as a Plan B, if zero-profile with embedded screws don´t give enough bony anchorage. This is to avoid the need for additional dorsal fusion with pedicle screws in most comparable cases.
The reposition and alignement is made under x-ray, thus the surgeon can control the exact positioning. The embedded screws counteract levering and rotation, thus enabling bony healing of the vertebral bodies and the cage.
That means there are some fusion system will only require anterior procedure, no posterior instrumentation required. Are they FDA approved? Has anyone heard about AXLE system?
I realize most surgeons would choice one approach, which he becomes a master for this approach. Choosing different technique will mean to choose different surgeon. New technique will always be more risky!