This very innovative minimally invasive approach is used for anterior lumbar fusion from L1 to L5. This procedure is not effective for L5-S1. Through very small incisions in the flank, a complete discectomy and adequate exposure for fusion is possible. This procedure can be used to treat spondylolisthesis, recurrent disc herniations, foraminal stenosis, degenerative disc disease, degenerative scoliosis as well as pseudoarthrosis. In addition, this approach lends itself to minimally invasive disc replacements. This procedure can be performed on an outpatient basis through small incisions.

STEP 1 - Patient is placed in side lying position and the skin is marked where the center of the disc is on fluoroscopic images.

STEP 2,- The first incision is made in the flank, and the abdominal sac (the peritoneum) is pushed off of the abdominal wall by finger dissection (see insert).

STEP 3 - The second incision is made directly on the side of the patient, and a dilator is placed. Fluoroscopic images are taken to confirm position in the center of the disc.

STEP 4 - A probe is advanced through the psoas muscle. This muscle can have nerve roots traversing on its surface. This is why the end of the probe is sensitized to detect the proximity of nerves so that the nerve can be avoided.

STEP 5 - Dilators are placed to push the muscles out of the way, and a specialized retractor is placed onto the spine.

STEP 6 - The disc material is removed with currettes, and trial implants are placed.

STEP 7 - The implant is inserted.

STEP 8 - The two small wounds are shown, along with the post-operative radiography

The patient is shown on the first day after the operation.