Comparison of the different surgical approaches for lumbar interbody fusion

Nursing care of the patient undergoing lumbar spinal fusion

“…This approach provides the surgeon with direct access to the disc space, which facilitates bilateral decompression and interbody fusion through one incision. [13] Alternatively, the surgeon may perform transforaminal lumbar interbody fusion (TLIF). TLIF carries less risk of neural injury than PLIF because it requires less neural traction.…”

“…TLIF carries less risk of neural injury than PLIF because it requires less neural traction. [13] Both posterior approaches avoid the risks of vascular injury, abdominal wall injury, and autonomic complications that are associated with the anterior approach.…”

“…[14,15] However, the anterior approach is also associated with increased risk of vascular complications, visceral injury, retrograde ejaculation, and sympathetic dysfunction because of the proximity of the major vessels, abdominal organs, and hypogastric plexus to the surgical dissection. [13,16] Severe obesity or extensive scarring from previous abdominal surgery may preclude the anterior approach. [13] 5.3 Anterior and posterior approach fusion In select cases, the surgeon uses a combined anterior and posterior approach to lumbar fusion (APF).…”

“…[13,16] Severe obesity or extensive scarring from previous abdominal surgery may preclude the anterior approach. [13] 5.3 Anterior and posterior approach fusion In select cases, the surgeon uses a combined anterior and posterior approach to lumbar fusion (APF). The combined approach provides greater mechanical stability and improves the likelihood of a solid fusion.…”

“…However, APF is associated with longer operative time, greater intraoperative blood loss, more complications, and longer length of stay. [13,14] Consequently, this approach as a percentage of all lumbar fusions is decreasing in frequency. In 2002, APF comprised 10% of all lumbar fusions; by 2010, APF made up less than 1% of all lumbar fusions.…”