Exposure for Spinal Surgery
Anterior Lumbar Vertebral Exposure – (Exposure for Spinal Surgery)
The initial investigations and discussions regarding your back disease and the treatment options available to you will be performed by your spinal surgeon. My involvement occurs once the decision for an anterior approach has been made. All patients having the surgery will be assessed pre operatively both clinically and with an ultrasound of the major vessels of the abdomen and pelvis. You may have other investigations (such as CT) ordered as necessary. Your spinal surgeon will arrange for routine medical checks and blood tests to be performed.
The procedure is performed under general anaesthetic and several monitoring devices are employed for maximum safety. A urinary catheter is routinely placed. Monitoring of the blood flow to your feet is routinely achieved with non invasive probed placed on the big toes of both feet.
The incision used for your operation depends on the spinal surgery required and your past medical and surgical history, and the results of your pre-operative investigations. We routinely use a ‘cell saver’ suction system which allows any blood lost to be washed and returned to you. After the skin incision, the dissection is gently deepened to the envelope surrounding the muscles of the abdominal wall. The envelope is opened but no muscle is divided. The envelope surrounding the intestines is identified and kept intact allowing the abdominal contents to be gently retracted toward the middle. The ureter, arteries and veins are identified and protected, and retracted out of the area required to safely perform the disc surgery. Any nerves encountered are likewise protected. It may be necessary to use some blood thinner to protect the blood supply to the legs. At the end of the spinal procedure, the area is checked to ensure no bleeding and the blood supply to the legs is likewise checked to ensure it is intact. The abdominal contents are allowed to return to their usual position and the muscle envelope, subcutaneous tissues and skin carefully closed.
The entire procedure including the neurosurgical procedure usually takes between 2 and 4 hours.
Post operatively you are carefully monitored in the recovery room and the ward, including vascular observations. After the operation, the intestine often has a period of slowed mobility, and it is usual to fast you for 1-2 days. Your spinal surgeon will discuss the movement and lifting restrictions carefully with you before and after the operation.
The operation is usually safe and I have an extensive and growing experience with the procedure. There are some possible complications associated with the procedure however. These include anaesthetic complications and death (1-2% in the literature), injury to surrounding structures (including the bowel, ureter, bladder), bleeding, infection, Deep Venous Thrombosis, Arterial occlusion, nerve damage, male sexual dysfunction, later hernia formation and other rarer complications. Fortunately, we have not experienced any severe complications or deaths.
Post operatively, careful monitoring of your spinal nerve function as well as blood supply are employed. Fasting is usually continued for 24 - 48 hours.
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