THElumbar arthrodesis anteriorly is a surgical procedure commonly used in surgery of the spine. What exactly does it consist of? How is it going? What makes it different from other types oflumbar arthrodesis ? This article will answer these questions.
Reminder on definitions
Le Lumbar spine is located in the lower part of the spine. It is composed of 5 vertebrae (L1, L2, L3, L4 and L5). These vertebrae are separated from each other by the intervertebral discs which act as a shock absorber. At each vertebral level there are holes called foramen where nerve roots come out.
The lumbar spine creates a concave backward curvature known as the lumbar lordosis.
La lumbar spine articulates at the top with the dorsal spine and below with the pelvic bone (sacrum). It is mobile and supports the rest of the spine. It is in high demand on a daily basis. It is for this reason that the lumbar region is often the seat of various pains.
Lumbar arthrodesis corresponds to a surgical intervention which consists of the consolidation of at least two pathological vertebrae. The objective of this operation is to stabilize the spine.
At the lumbar level, arthrodesis can be indicated in several situations such as:
- a lumbar scoliosis ;
- un spondylolisthesis ;
- a vertebral fracture spine;
- a lumbar arthritis ;
- a spinal stenosis (narrow lumbar canal);
- a herniated disc...
What are the types of lumbar arthrodesis?
There are 3 types of lumbar arthrodesis. Although these approaches differ from patient to patient, the success rate of arthrodesis is generally high.
Lumbar arthrodesis by posterior approach
The opening will be at the level of the back. It is realized either by a open surgery », which requires a large skin opening to allow the surgeon to visualize the operated area, that is, under endoscopic control (using an endoscope).
Lateral lumbar arthrodesis
The incision is made on the side of the stomach. It is indicated to treat degenerative disc disease, spondylolisthesis and degenerative scoliosis. Its purpose is to remove the diseased disc causing the pain and thus block mobility between two vertebrae.
Anterior lumbar arthrodesis
THEanterior lumbar arthrodesis takes place in the abdomen. It also involves removing the affected disc by replacing it with a bone graft.
Zoom on lumbar arthrodesis by anterior approach
Lumbar arthrodesis by anterior approach is mainly recommended in case of degenerative disc disease (L4L5 or LS1) who do not respond to medical treatment. Its practice is debatable if the pain is disabling or resistant to other treatments (such as physiotherapy, rehabilitation, medical measures).
THEanterior arthrodesis of the lumbar spine may also be considered if the patient suffers from degenerative lumbar spondylolisthesis, disc or joint osteoarthritis, spinal instability (lumbar instability) or lumbar scoliosis.
How is the intervention carried out?
During the operation, the patient must lie on his back and is under general anesthesia.
The surgeon first installs an imaging system (2D or 3D) in order to locate the ideal trajectory as well as the pathological disc. He then makes an incision of about 5 cm to open the envelopes of the abdominal muscles. This will bypass the pocket that contains the intestines (peritoneum) and release the diseased disc.
The establishment of a protection on the blood vessels (in particular the iliac veins and the arteries) is an essential step during a anterior lumbar arthrodesis.
To guarantee the stability of the vertebrae during the operation, a retractor is fixed with small pins at the level of the bones of the vertebrae. The surgeon can thus visualize the vertebral column and remove the damaged disc (discectomy). He then prepares the bony surfaces of the vertebrae for the placement of the "cage" in the disc space in order to create the fusion of vertebrae. The cage is previously filled with bone graft.
Subsequently, the surgeon performs a osteosynthesis. This is to fix the vertebrate by a plate and additional screws. And finally, he closes plane by plane and removes the expansion tube.
A anterior lumbar arthrodesis usually lasts 1-2 hours.
After the operation, the doctor prescribes injections of anticoagulants. But, it is also possible to wear compression stockings (only during the day) for a fortnight.
In most cases, the patient feels a residual pain after surgery. It is generally related to the separation of the muscles during the operation. Turnkey hip pain ou in the legs can also show up early, and usually dissipate over weeks. The exact duration of pain vary depending on the patient's condition and the symptoms present before surgery.
Rest assured, the prognosis is generally favorable, and the majority of patients observe significant progress and a return to their activities.
Analgesics and anti-inflammatories are prescribed to relieve pain during hospitalization and at home. You can go home the day after the operation. You can get into a car while remaining seated, although it is not recommended to drive.
A lumbar belt or a corset are sometimes recommended, but they are not mandatory. They protect against false movements and can help resume activities without fear of regenerating pain.
A nurse can provide scar care at home. On the tenth day, the threads can be removed.
If your dressing is waterproof or the surgeon has applied a protective biological glue, you can immediately take a shower. However, always keep the scars clean and dry.
Rehabilitation can be recommended after 1 month followed by a control visit at the sixth week. It is done with a physiotherapist. Physiotherapy essentially aims to strengthen the abdominal strap and tone the paravertebral muscles.
Each patient has their own pace of recovery after anterior spinal arthrodesis. The convalescence will therefore be personalized. The resumption of sports activities is generally after the third month. You can only perform sports without contact or twisting of the trunk (swimming, cycling, etc.).
As for returning to work, that depends on your age and your profession. If your job requires you to perform repeated movements or carry heavy loads, you may wait a while before returning.
Anterior lumbar arthrodesis: specificities
Compared to other types of arthrodesis, anterior lumbar arthrodesis makes it possible to better clean the disc and to put a more voluminous cage. The nerves are located behind the disc. Via the posterior route, they can get in the way during the operation and obstruct the passage of the large cage.
Since the incision is made on the front of the stomach, the surgeon will be able to access the spine without having to cut muscle fibers. So it keeps the muscles. In this case, it is less invasive than posterior arthrodesis.
To conclude, theanterior lumbar arthrodesis rarely presents with complications. Remember to ask your surgeon questions about everything related to the operation so that you are reassured on the day of the operation.
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