Within your spine, there are 33 bones called vertebrae that provide structure to your body and protect your spinal cord. Between each vertebrae, there are discs and joints that absorb shock and allow you to move and be flexible. As we age, the discs between our vertebrae lose water, lessening their ability to cushion the spine. This is a process called disc degeneration, which often reduces the space where nerves exit. A lot of people experience pressure or pinching on the nerves as a result of this condition, which causes tremendous pain.
Spinal Fusion
Spinal fusion is a surgical treatment option for degenerative disc disease and other spinal conditions such as scoliosis. By stabilizing and immobilizing the joint between two vertebrae, a fusion will alleviate pain and improve back function.
A common method used to fuse vertebrae is called an interbody fusion. In this case, the damaged disc is replaced with a specially designed cage that restores proper disc height and maintains proper alignment of the spine, effectively enlarging the space where the nerves exist. The cage will contain harvested bone and proteins that will encourage the two vertebrae to grow together.
Established Techniques
There are many approaches to accessing the spine for an interbody fusion. Approaching from the back, or  posterior, offers direct access to the spine. However, it also disrupts major back muscles and manipulates nerves, which can lead to pain and numbness after the surgery.
Approaching the spine from the front, or anterior, also provides good access to the vertebrae. It saves the muscles and nerves in the back, but it requires large incisions and involves the painstaking manipulation of organs and major blood vessels in the abdomen.
The Lateral Approach
More recently, doctors have developed an approach from the side (lateral) that offers numerous advantages over the established approaches. It is a minimally invasive technique in which the patient is positioned on his or her side.
After x-rays, the surgeon will mark the appropriate location for a small incision. Through this incision, the only muscle that will need to be cut through is the psoas muscle. Once the disc area is exposed, the surgeon carefully prepares the bones for fusion by removing that damaged disc and implanting the specialized cage.
Pros and Cons of the Lateral Approach
Benefits
Smaller incisions
Avoids major organs, muscles and blood vessels that may be disrupted by other approaches
Less chance of abdominal muscle weakness and hernias after surgery
Less blood loss and tissue trauma
Improved mobilization
Faster recovery times
Possible Complications
Thigh and/or groin pain or numbness as a result of disrupting the psoas muscle and surrounding nerves. These symptoms usually subside a few months post-op
When deciding on the appropriate approach, the surgeon will weigh the risks and benefits of each technique while considering the patient’s anatomy and condition. Discuss with your doctor which technique is right for you.
Sara Thompson writes about neuroscience and spinal health in collaboration with Dr. Todd Kuether, a neurologist in Portland, Oregon and member of the Society of Lateral Access Surgery.