Understanding Approach Procedures

Before surgeons can operate on the spine, organs and blood vessels need to be moved out of the way and kept safe. Dr. Hanan performs a range of spine approach procedures to protect these structures while providing surgeons with the access they need to the lumbar and thoracic spine. Dr. Hanan closes all incisions without staples or sutures to minimize scarring and uses ON-Q PainBuster® to continuously deliver local anesthetic, helping relieve post-op pain.

Lumbar Spine Approach

Most spine surgeries involve the lumbar, or lower, spine. To help surgeons access the lumbar spine, Dr. Hanan makes a vertical abdominal incision for the lowest lumbar level. Then, he moves and secures the intestinal track and blood vessels overlying the spine throughout the operation. When surgery is complete, Dr. Hanan returns the intestines and vessels and closes the abdominal incision.

Thoracic Spine Approach

To access the thoracic spine, Dr. Hanan makes a horizontal chest incision and removes the rib that blocks the target spine area. Spine surgeons can use the rib during the surgery as needed for bone graft. Dr. Hanan then moves the lung and blood vessels overlying the spine and keeps them safe throughout the operation. When surgery is complete, Dr. Hanan returns the lung and vessels and closes the chest incision using a special drain which is removed after a few days.

Thoracolumbar Spine Approach

Surgeries requiring operation on both the lumbar and thoracic spine generally involve deformities. In these cases, Dr. Hanan makes a vertical abdominal incision then extends it up and across the chest toward the back. He cuts the diaphragm separating the chest and belly to form a single cavity, removes the rib blocking the target spine area, and moves and secures the lung, intestinal track, and blood vessels overlying the spine. When surgery is complete, Dr. Hanan repairs the diaphragm, returns organs and blood vessels, inserts a chest tube to re-inflate the lung, and closes the incision.

Lateral Spine Approach

In some cases, Dr. Hanan can avoid making larger incisions on the abdomen and chest. He makes a small incision on the side, directly over the target spine area using the XLIF® lateral approach. A retractor instrument spreads tissues so that spine surgeons can operate on the spine. This minimally invasive procedure can result in less pain and faster recovery.