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

Purpose: Anterior spinal fusion has become an increasingly popular techniqu e used by orthopedic surgeons for a variety of lower spine pathology. At ou r institution urologists have assisted as retroperitoneal surgeons in achie ving exposure of the appropriate spinal disk space. We report our experienc e 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 transperit oneal 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 T1 2 through L5-S1 interspace was required, and exposure of multiple spinal le vels was necessary in 27. There was 1 death from massive pulmonary embolism in a patient with widely metastatic lung cancer. Retrograde ejaculation wa s reported by 2 men. There have been no episodes of deep or superficial wou nd infection and no ureteral or major vascular injuries. Conclusions: As surgeons of the retroperitoneum urologists have an importan t role in providing our orthopedic colleagues with safe, adequate exposure to the anterior surface of the spine during discectomy and anterior fusion.