These pictures illustrate the typical procedure:-
Retroperitoneal dissection is performed through the laparoscopic ports from the left side. The ureter and bowel are mobilised to expose the spine.
The disc is exposed. In this case the L5/S1 disc is exposed between the blood vessels. X-rays are taken after insertion of a needle into the disc to confirm the right level and angle of approach.
The midline port is inserted and a retractor inserted to aid exposure.
The position of the cages is marked with diathermy prior to drilling of the disc space.
The disc is drilled to allow insertion of the distraction plugs, used to restore height in the disc space.
Distraction plug being hammered into the disc space. X-rays are used to confirm appropriate size and depth of the disc.
Two plugs are seen in the disc space side by side.
The cages are screwed into the disc space after removal of the plugs one side at a time.
Cages in the disc space which are then packed with bone graft.