From the Guidelines
Spinal surgeries are performed using an anterior approach to minimize disruption of the epidural space and reduce the formation of epidural scar or granulation tissue.
Rationale for Anterior Approach
- The anterior approach is preferred for most cervical discectomies because it allows for direct access to the disc without transgressing the epidural space 1.
- This approach reduces the risk of epidural scar or granulation tissue formation, which can be a source of post-operative pain and complications.
- As a result, contrast-enhanced imaging is not routinely used after anterior cervical discectomy and fusion (ACDF), unless there are specific indications such as prior posterior-approach cervical fusion/decompressive procedures 1.
- The use of gadolinium-enhanced MRI may be considered in certain cases, but its role is more established in the setting of lumbar spine surgery rather than cervical spine surgery 1.
From the Research
Advantages of Anterior Approach
- The anterior approach to the spine provides excellent visualization and access to the anterior thoracic spine, vertebral bodies, intervertebral disks, spinal canal, and nerve roots 2.
- This approach allows for proper decompression of neural elements and spine stabilization, making it suitable for various spinal pathologies, including thoracic disk disease, vertebral osteomyelitis or discitis, fractures, and tumors of the vertebral bodies 2, 3.
- The anterior approach can be used for lesion excision, corpectomy, vertebral body reconstruction with cages, realignment, and/or plating or screwing, depending on the type of lesion being addressed 3.
Indications for Anterior Approach
- The anterior approach is commonly used for the treatment of complex spine pathology, including spinal deformities, tumors, burst fractures, infections, vertebral avascular necrosis, pseudoarthrosis, and other miscellaneous indications 4.
- Anterior-only treatment is more likely to apply to younger, healthier patients with normal bone stock and limited pathology, while combined anterior and posterior techniques are often used for patients with large deformities, borderline bone stock, and multisegmental pathologies 5.
Techniques and Approaches
- Various approaches to the spine are available, including transabdominal, paramedian retroperitoneal, lateral oblique retroperitoneal, thoracotomy, and thoracolumbar extensile 4, 6.
- The choice of approach depends on the location and length of spinal involvement, as well as the type of pathology being treated 2, 5.
- New retractors, instrumentation, hyperlordotic implants, approved biologics, and image guidance for disc preparation and precise implant placement are recent advances that aim to improve surgical outcomes in patients following anterior spinal surgery 4.