Type of Approach
When spine surgery is indicated, two approaches are used in the majority of cases. The posterior approach, which is the more common, is usually used for uncomplicated maneuvers. This is done with the patient lying face down in the prone position. An incision can be made over the spine in the back, and even smaller minimally invasive maneuvers can be done this way. Minimally invasive spine surgery, Micro-discectomy or Micro-decompression are terms which describe the procedure using a small incision and has been gaining popularity over the last decade.
More complicated problems often require an anterior, or less frequently a lateral approach. This is a surgery where the spine must be operated upon from the front or side, as the access needed is more extensive, and a wider area can be used. The patient is lying in a supine or face-up position, or sometimes a lateral or on-the-side position. Depending on what level the problem exists in the spine, the pelvis, the abdomen or the chest may be the zone which must be traversed.
The anterior approach can be used for Disc Replacement, or Anterior Lumbar Interbody Fusion (ALIF). A lateral approach can be used for a maneuver known as the Tethering Technique for scoliosis, or an Extreme Lateral Interbody Fusion (XLIF). Anterior and lateral approaches commonly require an Approach Surgeon, as the path to the spine is complicated and often involves moving structures aside. The Approach Surgeon is usually a General or Vascular Surgeon who assists the Spine Surgeon, as this is their area of expertise. The more complicated the approach, the more often an Approach Surgeon is required.
When is a Spine Approach Surgeon involved?
Usually the spine surgeon will arrange for an additional set of hands depending on the complexity of the case, the patient’s health status, the approach, and the structures which may be in the way. Examples of structures which may need to be retracted are the Aorta, Vena Cava, Iliac Artery or Vein, Spleen, Liver, and Kidneys. Sometimes the approach will need to traverse the chest cavity, so the Approach Surgeon will need to gain access to the spine by taking down the Diaphragm, and then repairing it at the end of the spine surgery.
Are all General Surgeons Spine Approach Surgeons?
Most General Surgeons indeed DO NOT perform approaches to the spine, and in fact, there are very few surgeons who have this type of experience and breadth of knowledge. Usually the Spine Surgeon will have worked with one or two individuals over the course of their career, where a significant amount of trust has been built between them. When a conversation about an operation takes place between the patient and the spine surgeon, the aspect of an approach surgeon will be discussed.
Who is the most experienced Approach Surgeon in the New York Area?
Dr. Sergei Dolgopolov is one of the most experienced Approach Surgeons in the New York area. He has practiced surgery for 35 years, and has been providing an extremely high level of care to hundreds of patients in this regard for nearly 20 years. Dr. Dolgopolov has worked with a multitude of different Spine Surgeons during this time, some of whom are the most prominent in the world. His care includes the choice of incision in regards to the anatomical aspects of the procedure, protection of the structures both vascular and otherwise, and monitoring in the post-operative period. As spine surgery has grown and become infinitely more complicated, Dr. Dolgopolov’s continued presence in the field for the last 20 years has enabled him to be part of, and even instrumental in the advances we have seen.