My Spine - Lumbar
Sometimes the specialist will perform an ALIF at the lowest level of the lum-
bar spine (L5/S1) and perform an artificial disc arthroplasty on the level
directly above (see the chapter Lumbar Total Disc Arthroplasty).
This is frequently performed where the two lowest discs in the spine are dam-
aged and allows the upper level to move freely and not place stress on the lev-
els above.
When undergoing this operation, you will be lying on your back. Your spe-
cialist will make a small cut across your belly. This cut can vary from four to
ten centimetres to a slightly larger cut, depending on technical factors. It can
be a cut across your belly in the position where a cut is sometimes made for
a caesarean section or slightly higher, closer to the belly button.
The length of the cut is actually of little consequence to the success of the
operation and your specialist would never complicate the operation by limit-
ing the length of the cut. In some cases the specialist will operate through the
abdominal sac (peritoneum) that houses the abdominal organs. In other cases
the specialist displaces the peritoneum which contains the abdominal organs
to one side and then reaches the spine without penetrating into the cavity
(peritoneal cavity).
Your specialist then has to temporarily displace the great vessels (aorta, iliac
artery, vena cava and iliac vein) away from the disc space. Furthermore, the
tubes that carry the urine might be in the way and have to be displaced too.
The sympathetic nervous system that regulates the lymph flow in the legs as
well as erection and ejaculation in males and vaginal lubrication in females,
can also be violated in the procedure. Your specialist should have appropriate
training in performing this approach before embarking on this procedure.
When the vertebrae are encountered, the outer ring of the disc is normally
incised, opened like a trapdoor and then the entire core of the disc is removed.
Thereafter, the implant, which may be a spacer filled with the patient’s own
bone, bone from the bone bank or synthetic material (inducing bone-growth)
is placed in the previously distracted and prepared disc space.
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