Exposure of the anterior spine: Technique and experience with 66 patients

Purpose: Anterior spinal fusion has become an increasingly popular technique used by orthopedic surgeons for a variety of lower spine pathology. At our institution urologists have assisted as retroperitoneal surgeons in achieving exposure of the appropriate spinal disk space. We report our experience with anterior spinal fusion in 66 patients. Materials and Methods: Since 1991 we have performed 66 exposures using the flank, modified Gibson, thoracoabdominal, paramedian and midline transperitoneal approaches. Exposure of each level has subtle technical issues which are reviewed. Results: During the study 34 men and 32 women 24 to 74 years old (mean age 43.8) underwent discectomy and anterior fusion of the spine. Access from T12 through L5-S1 interspace was required, and exposure of multiple spinal levels was necessary in 27. There was 1 death from massive pulmonary embolism in a patient with widely metastatic lung cancer. Retrograde ejaculation was reported by 2 men. There have been no episodes of deep or superficial wound infection and no ureteral or major vascular injuries. Conclusions: As surgeons of the retroperitoneum urologists have an important role in providing our orthopedic colleagues with safe, adequate exposure to the anterior surface of the spine during discectomy and anterior fusion.