Anterior vs Posterior Fusion?

How do you decide between anterior vs posterior fusion for your patients?

My preference anytime a disc is painful, unstable, crooked or collapsed, is to always go anterior to remove it and place structural bone graft. I believe strongly that it provides a more reliable fusion since the graft is larger, the disc can be removed under direct vision more thoroughly, and the disc height and alignment can be improved significantly more with an anterior approach. The only time I fuse the disc space from a lateral or a posterior approach is when access the the front is too risky (the patient has had an anterior surgery previously) or the disc is not accessible from the front- usually any level above L1. ~Dr Cyr

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