This surgery is typically performed at the L5-S1 level. A 3-inch incision is placed on the very lower part of the abdomen (above the front part of the pelvic bone). The abdominal contents are moved to the side and the the L5-S1 disc is exposed. The degenerative intervertebral disc is removed and a plastic spacer (packed with bone graft, BMP, and/or allograft) is inserted between the vertebral bodies to distract and realign the adjacent vertebrae and relieve the pressure on the nerves.
This procedure can take 60 to 90 minutes depending on degeneration and deformity. Most patients stay in the hospital for 2-3 days and then go home. For patients with an isolated L5-S1 problem this is the best procedure because: it provides the most biomechanical stability, does not require any dissection (cutting) of the back muscles and thus causes less pain than a posterior approach. Depending on the extent of the problem, posterior screws may also need to be placed to achieve stabilization. If this is the case, these screws are placed in a minimally invasive fashion through 1-cm incisions on the back without the traditional muscle cutting technique. Whether or not a patient needs screws is dependent on an individual’s bone quality, pathology and other medical conditions. It is generally discussed preoperatively.