For some years now, the preferred surgical treatment of cervical disc disease has been to approach the cervical spine from the front. This has a number of advantages over the older, posterior technique, which approached the spine from behind, including direct access to the disc space and the avoidance of manipulation of nerve roots, or the spinal cord.
Approaches to the lumbar spine from anteriorly (e.g. “through the belly”) are becoming more popular, as experience is gained from similar approaches to the cervical spine (neck), as well as the increasing use of endoscopic instrumentation. This procedure avoids direct contact with the nerves and dura, which are located behind the vertebral bodies, and may be appropriate where this is desirable.
Excision of the intervertebral disc, in this approach, is generally followed by the insertion of a bone graft, “stand-alone cages”, or a combination of fusion and plating. Potential complications, which may limit this approach, include injury of the major blood vessels (e.g. aorta and vena cava) and development of retrograde ejaculation in men. Techniques are also being developed for lateral (from the side) approaches to the lumbar discs, and this may prove satisfactory for some conditions.