The Operation

How long does the surgery take?

Depending on your medical condition, the complexity of the problem affecting your spine and the number of levels to be fused, the two operations may be undertaken in one sitting or separated by an interval of seven to ten days. For a straightforward case atone level the two operations together usually take four to five hours.

Where are the incisions made?

There will be two incisions. The first, on the back, will be a midline incision made over the levels to be fused. This will be relatively long, about 10 to 12 cm for a single level operation. The reason for this is that a longer incision is actually kinder to the spinal muscles, allowing more gentle and less damaging retraction. For the anterior surgery the site of the incision will depend on the levels being fused. At L5/S1 (the lowest level of the spine) the operation will be done through the lower part of the abdomen. The incision, which can be as little as 5-6 cm in a slim patient, is usually a little above the pubic hair line. The rectus muscles at the front (the 'six-pack muscles') will be moved apart but not damaged. For levels above this the incision will be on the left side, usually just above the top part of the pelvis. Again, this is usually about 5-6 cm. The flank muscles are separated but not cut or damaged.

What happens during the procedure?

The operation from the back is usually done first. After making the incision and moving the muscles sufficiently to reach the insertion point for the screws these are placed down the pedicle into the vertebrae of the levels concerned. The placement of the screws is checked very carefully using feeler gauges and x-ray control. The rods are positioned into the locking mechanisms of the pedicle screws and any adjustments made to achieve proper alignment of the vertebrae. The rods are then locked firmly in place. Bone graft is required for the fusion procedure. Sometimes sufficient graft is obtained from bone removed during the operation but if not bone graft will be obtained from shavings from the pelvis. This can usually be obtained through the same incision. An epidural will be positioned to help with post-operative pain control. The wound is then closed with a small wound drain being inserted. Small clips are used to close the skin edges.

The operation on the front of the spine is performed next. After separating the muscles the peritoneal sack, containing the abdominal organs, is carefully moved to one side. A marker is placed on the disc and an x-ray obtained to confirm the level where the fusion is to be undertaken. The large blood vessels in front of the spine are then carefully moved to give the necessary access to the disc, which is carefully cleared away.

The appropriate size of STALIF cage then determined using trials and x-ray control. The cage is then packed with bone graft or a bone graft alternative. Additional graft material is packed at the back of the disc space before the cage is inserted. Placement is meticulously checked as the STALIF cage is inserted. The cage is then fixed very firmly in place using the screws which pass through the cage and into the vertebral bodies. Additional bone graft is also packed to either side of the cage.

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