Lumbar spine surgery via abdominal approach
Surgical interventions present a wide range of indications and needs to correct acute or chronic problems. With regard to spinal surgical treatment, thanks to advances in biomedical sciences, engineering, as well as improvements in protocols and the quality of imaging tests, it is possible to make full predictions before an intervention regarding the material required, the approximate surgical time, and improve the choice of a less aggressive approach, treating the pathology completely, allowing us to achieve an effectiveness that was difficult to imagine a few decades ago.
What is abdominal lumbar spine surgery?
This is a selective intervention performed via an anterior approach to treat severe disc disease that affects the biomechanics of the lumbar spine. It requires a correct etiological diagnosis and assessment of the segment to be treated, as well as ruling out secondary diagnoses and assessing the presence or absence of neurological complications and instabilities that require fixation.
Indications for lumbar spine surgery via abdominal approach
This intervention is mostly indicated for moderate to severe lumbar disc disease that does not require surgical treatment via a posterior approach, such as joint hypertrophy or foraminal stenosis due to posterior osteophytes. While disc disease can persist for a long time and continue to cause constant symptoms with recurrent attacks, chronic lesions with osteoarthritis or posterior joint deformity can produce both central and foraminal stenosis, causing very specific symptoms depending on the level of compression. These symptoms are justified by failure of conservative treatment or ongoing and evolving neurological involvement. A particular indication for the anterior approach is usually seen in disc disease, especially at the L5-S1 or L4-L5 levels, with a thorough assessment of whether it will be possible to avoid vascular injury during the procedure. An experienced surgeon understands these concepts very well and, before proposing this treatment, will have made an accurate diagnosis and explained the therapeutic alternatives in your case.
How is lumbar surgery performed via the abdominal approach?
It is performed in the operating room under general anesthesia, for which a preoperative examination with the anesthesiologist is necessary, which may be done a few days beforehand. During the procedure, a fluoroscope is also used to locate the area to be treated, marking it before the incision and using it to monitor the procedure to avoid errors and treat unaffected segments. The procedure usually lasts 60 minutes on average and consists of removing the disc causing the problem with the placement of a prosthesis that will allow proper movement of the segment once it consolidates in the vertebral body, or a fixed disc that will prevent the segment from moving incorrectly and damaging the nerves exiting the spine, as well as preventing the progression and development of osteoarthritis in the posterior joints.
Recommendations before and after lumbar surgery via abdominal approach
Before undergoing this procedure, a thorough medical evaluation and appropriate lumbar support with posterior reinforcement are recommended. The procedure has different protocols that will be specified according to the patient's health status, but a one-night hospital stay and discharge the following day are recommended. Patients are advised to rest for three weeks, as well as prophylactic medical treatment with anticoagulants, anti-inflammatory drugs to treat inflammation caused by the surgery, and surgical wound care, which can be easily performed at home if a family member is present. Before authorizing home discharge, an X-ray will be performed to assess the material placed in the spine and an assessment with early indications for physical therapy and spinal care prior to the surgery. If you are a smoker, it is recommended to quit smoking or limit activity to a minimum, as this delays the consolidation of the material and can prolong the postoperative period by several weeks.
Seguimiento a la cirugía lumbar por vía abdominal
After 15 days following the procedure, the surgical team will assess the patient's progress, and the patient's postoperative period can begin to gradually integrate with mobility and mobility measures promoting muscle strengthening and nutritional recommendations. Radiographic follow-up with two assessments scheduled at one and three months after the procedure will also be performed. If necessary, the patient's condition will be assessed at all times, especially if circumstances outside the protocol may arise, such as falls at home, surgical wound infections, or pain that is difficult to manage due to medication intolerance or side effects. Recommendations to return to daily life without exertion may be indicated starting in the third week, including the start of physical therapy prior to gradually returning to daily life. Driving is permitted starting one month after surgery, unless specifically directed by the surgeon.
Recuerda que esta información está hecha con fines de divulgación y que sólo un especialista en columna vertebral, indicará cual es el tratamiento oportuno para tu problema de columna vertebral.
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