Anterior and posterior surgery is generally recommended for spinal curves that are very severe, stiff, or when previous attempts at fusion have failed.
Combined Anterior and Posterior Approach
When performing a spinal fusion from the posterior approach (the back side), it is possible to move the spinal nerves to the side and place bone graft in between the vertebral bodies themselves. This is sometimes referred to as a "posterior lumbar interbody fusion" (PLIF). Today, surgeons are also beginning to place intervertebral cages between the vertebral bodies to hold the two vertebrae apart as the fusion heals. In some cases, this can be done from the back side of the spine without the necessity of making an additional incision in the patient's abdomen (from the front).
Working between the vertebrae from the back side has limitations. The surgeon is limited by the fact that the spinal nerves are constantly in the way. These nerves can only be moved a slight amount to either side. This limits the ability of the surgeon to see the area. There is also limited room to use instruments and place implants between the vertebrae. For these reasons, many surgeons prefer to make a separate incision in the abdomen and perform two operations three quarters from the front of the spine to perform an anterior spinal fusion. In addition an incision is made from the back to perform a posterior fusion. The two operations are usually done at the same time; however, this is not necessary. They may be done several days apart.
