I am going to have a lumbar spine fusion at the L45 level. The procedure involves a "lateral" approach. I understand the angle and direction. I'm just not sure why this is such an important point for the surgeon to make to me as a patient. Is there something magical or extra special about this?

There are many different ways to fuse the spine. The surgeon must get to the spine before performing the actual fusion. The anterior approach (from the front of the body) avoids the spinal cord and spinal nerve roots but involves moving large blood vessels out of the way without damaging them. The approach requires the surgeon to cut through muscles and soft tissues close to the spinal cord and other nerve tissue. Both the anterior and posterior approaches have definite disadvantages. That's why the lateral approach was developed. It sounds like you may be having a fusion procedure referred to as a transforaminal lumbar interbody fusion or TLIF. The word "transforaminal" is what is meant by "lateral". The TLIF method of lumbar fusion has many advantages. The lateral approach gives the surgeon access to the disc and disc space without applying excess pull or traction on the nearby spinal nerve. With a lateral approach, it is only necessary to remove one spinal joint (rather than the joints on both sides of the spinal level being fused) in order to get to the disc space. Once the surgical approach and method are selected, then the surgeon decides whether to do this procedure as an open (oTLIF) or minimally invasive (mTLIF). Just as it sounds, an open incision is done by cutting through the skin, muscle, and other soft tissues in order to give the surgeon a full view of the spine. In a minimally invasive TLIF (mTLIF), a long thin tube is passed down through the skin, fascia, and muscle down to the spine. It is not necessary to dissect (cut through) all these layers of soft tissue. Surgical instruments and hardware (cages, screws) used to fuse the spinal segment are passed through this tubular retractor system. A minimally invasive approach reduces blood loss during the procedure and postoperative pain afterwards. Hospital stays are shorter with the mTLIF, which means lower costs. Other advantages of the minimally invasive approach have been reported. For example, there is less damage to the muscles and less tissue trauma overall. Fusion rates are equally good between the open and minimally invasive methods with lower costs and complication rates for the minimally invasive technique.

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