Up to three disks can be approached using the same 4-cm incision through a “sliding window” technique without the need to extend the incision, by taking advantage of the mobility of the abdominal wall. The described minimally invasive technique is well suited for exposure of L2–L3 to L4–L5 disks, but rarely, L1–L2 and L5–S1 disks can also be exposed. Exposure of L1–L2 disk is limited by the chest cage and can be performed only in the presence of relatively horizontal and mobile floating ribs. As for L5–S1 disk, its access is limited by the iliac wing and by the need to mobilize iliac vessels.

After diskectomy (Fig. 30.2a), vertebral endplates are prepared in order to expose the subchondral bone. The cage is filled with bone graft and/or substitute (Fig. 30.2b) and inserted in a press-fit fashion into the exposed disk spaces that remained open after the posterior procedure (Fig. 30.2c). If required, autogenous iliac graft can also be harvested from the same incision. Abdominal muscle planes are closed sequentially and the skin is closed using subcutaneous and subcuticular sutures (Fig. 30.1d). Although the procedures were performed without magnifying loupes or surgical microscope, it can be used for improved vision. In addition, a headlight or better a small light inserted in the wound by the retractors can be useful especially in deepest or overweight patients.