Laparoscopic Exposure For Spinal Fusion

A. The Condition. You may have a condition of your spine that will be corrected with surgery (spinal fusion). Your spine surgeon may want the region of the spine prepared by a laparoscopic surgeon so that the spine surgeon can treat your condition. This preparation is called spinal exposure.

B. Symptoms. The symptoms you have likely will be related to your spinal condition.

C. Laparoscopic Exposure For Spinal Fusion. The surgeon will make about 3-4 small incisions in your abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see inside of your abdomen more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to perform the spinal exposure. This will involve moving your intestines around and dissecting around some large blood vessels. These maneuvers will allow the spine surgeon to get access to the spinal vertebrae, so that corrective surgery can be performed. Your spine surgeon will discuss the specific steps of the corrective surgery with you. After the spine surgery has been accomplished, the carbon dioxide is released out of the abdomen through the slits, and then these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips.

Dr. Frantzides was given the Award for the “Best Multi-Disciplinary paper” on Laparoscopic Spinal Fusion by the American Society of Laparoscopic Surgeons in 2006.

D. Nonsurgical Treatment. Your spinal surgeon will discuss with the nonsurgical options for treatment of your spinal condition.

E. Risks. The primary risks of laparoscopic exposure for spinal fusion are:

• Infection of the skin at one of the small ports sites
• Intestinal injury
• Postoperative ileus (the intestines slow down/stop working for several days)
• Injury to a major blood vessel (for example, the aorta)

F. Expectations

1. Before Your Operation. Laparoscopic exposure for spinal fusion is usually an elective procedure. The preoperative evaluation might include blood work, urinalysis, and extensive x-rays/CT scans/MRIs of your spine. If you smoke, then you should stop immediately. If you are taking blood thinners (for example, aspirin, coumadin, Lovenox, or Plavix), then you will need to stop these one week prior to your procedure. Your surgeon and anesthesia provider will review your health history, medications (including blood thinners), and options for pain control.

2. Your Recovery. You usually can go home 3-7 days after a laparoscopic exposure for spinal fusion. You may have to wait for your bowels to start working You will be given medication for pain. You should limit your activity to light lifting (no more than 15 lb) for one month. Your spinal surgeon may have other instructions for you to follow.

3. Call Your Surgeon if you have one or more of the following:

• Severe pain
• High fever
• Odor or increased drainage from your incision
• No bowel movements for three days
• Nausea, vomiting, and/or crampy abdominal pain

Pertinent References

Frantzides, C.T., Zeni, TM, Phillips, FM, Mathur, S, Zografakis, JG, Moore, RE; L5-S1 Laparoscopic Anterior Interbody Fusion; J. Soc. Laparoendosc. Surg. 10 (4): 488-492, 2006.