Anterior Lumbar Approaches

Question 1

Anterior Approach Access Considerations

Answer 1

1. Goal is to avoid neural injury
   
   • Lumbar Plexus
   • Genitofemoral Nerve
   • Sympathetic Chain
2. Utilize expert monitoring
   
   • Technician on site
   • Multiple modalities
3. Sequential dilation

Question 2

2 Anterior Approaches:

Answer 2

1. Standard Supine

2. DaVinci (between the spread open legs of the patient

Question 3

Prep Considerations

Answer 3

1. Age
2. Gender
3. BMI
4. Co-Morbidities
5. Prior surgical history
   6.

Question 4

High

Answer 4

All abdominal organs are in Peritoneal Sac

Question 5

Be careful of which arteries when dissecting

Answer 5

Segmental Arteries

Question 6

Anterior Approach benefits

Answer 6

1. Good surgical approach
2. Complete diskectomy
3. Preservation of posterior elements
4. Anterior column support

Question 7

Anterior Approach - Risks

Answer 7

1. Vascular injury
2. Nerve injury
3. Infection
4. Visceral injury (organs)
5. Retrograde ejaculation
6. Adhesions (scar tissues around intestines)

Question 8

Why would a surgeon order an Imaging Study

Answer 8

Concern about stress or disruption of aorta

Question 9

Anterior Interbody spacers

Answer 9

1. Allograft
2. Synfix
3. Cougar

Question 10

Anterior vs Posterior depends on:

Answer 10

1. Number of diseased levels
   
   • needs to be below bifurcation if anterior
2. Overall Stability
   
   • can put a larger spacer in
3. Sagital Alignment
4. Patient History
5. Surgeon preference/training