What is the "anterior approach" operation for lumbar disc herniation?

The "anterior approach" surgery for lumbar disc herniation means that the operation starts from the front side of the body, that is, the abdomen, and enters the front of the lumbar spine layer by layer to remove the disc. The "anterior approach" was originally adopted through abdominal cavity, but it can cause gastrointestinal dysfunction such as intestinal obstruction after operation, and now it is mostly adopted through extraperitoneal approach. The typical process is as follows.

(1) The patient lies on his back, and the position for intervertebral disc surgery is aimed at the renal pad that can be raised on the operating table.

(2) Take a median incision about 20cm away from the abdomen, cut the sheath of rectus abdominis, and push rectus abdominis, extraperitoneal fat and ureter to both sides to expose the sacrum angle.

(3) There are nerve plexus and important blood vessels in front of the sacral angle. The exposed lumbar intervertebral space, sacrum 1 should be at the distal end of the bifurcation between abdominal aorta and inferior vena cava, and the exposed lumbar intervertebral space should be above the common iliac artery and vein. Carefully pull open the blood vessels to expose the anterior longitudinal ligament. Lumbar arteriovenous can be ligated.

(4) Fan-shaped incision of the anterior longitudinal ligament and annulus fibrosus, and upturning to expose the nucleus pulposus.

(5) Take out the nucleus pulposus and cartilaginous disc with nucleus pulposus forceps and curette, from shallow to deep, until only the fibrous ring is left.

(6) Chisel away the cartilage at the upper and lower edges of the vertebral body with bone to expose cancellous bone.

(7) Incision was made at the iliac crest, and iliac bone pieces were taken for bone grafting according to the predetermined size.

(8) Shake the renal pad on the operating table, enlarge the opening in front of the vertebral body, put the renal pad flat after inserting the bone graft, reduce lumbar lordosis, and stabilize the bone graft in the intervertebral space.

(9) Suture the fibrous ring and the anterior longitudinal ligament, and suture the surgical incision layer by layer.

Because of the fusion of vertebral bodies, patients after "anterior approach" surgery should stay in bed strictly for 3 months, and X-ray can confirm the fusion of vertebral bodies before going to the ground.