On December 4th, I performed an anterior/posterior reconstruction for a 38 yo young lady from the coast of North Carolina.
She had previous scoliosis surgery in 2004, but developed increasing low back pain.
She does have a history of smoking, which can contribute to disc degeneration.

I performed an anterior removal of her lower 2 remaining discs at L45 and L5S1, and replaced them with titanium anterior lumbar interbody fusion (ALIF) Synthes cages packed with bone graft.
After completing the anterior procedure, she was turned prone, and I extended her fusion down to the sacrum and ilium with titanium hardware.
I also performed posterior osteotomies at L4 and L5, which allowed me to create greater lumbar lordosis when combined with the anterior cages “strutting up” the front portion of the spine.
I actually used the operating room table in a special way to enhance the lumbar lordosis during rod placement.
Total surgical time was 6 hours.
She did not need to go to ICU, but to our spine/orthopaedic unit which allows family members to sleep in same room on a real bed!

Postoperatively, she did just great, with better standing posture, and good relief of her previous discogenic pain L45 and L5S1.
One of the things the patient had noticed when her 2 lower discs settled over the past 3 years, is that she lost her normal lower back and buttock shape.
You can see on her preop standing lateral X-ray where I put the 3 red arrows that her skin line is relatively straight down across the lower lumbar area and buttock.
Postoperatively, you can see clinical photo which shows a normal-appearing lower back and buttock contour — the flat back is is gone!!

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC  USA
http://www.HeyClinic.com