Complications of the Lateral Lumbar Transpsoas Approach

Abstract

The lateral transpsoas approach to the spine, popularized by Pimenta and colleagues in their 2006 landmark technical report [12], has gained increasingly widespread use by spine surgeons seeking to perform lumbar interbody fusion in a minimally disruptive fashion. Essentially an adaptation of the retroperitoneal approach to the spine, the technique may be viewed as a paradigm shift in interbody fusion, offering a unique and innovative solution to the problem of achieving robust reconstruction of the anterior column while avoiding injury to critical stabilizing structures of the spine. The lateral approach offers advantages over PLIF/TLIF in that retraction of the intraspinal neural elements is entirely avoided, along with the attendant complications of cerebrospinal fluid (CSF) leak, trauma to the exiting and traversing nerve roots, epidural fibrosis, and arachnoiditis. As experience with the lateral approach grows, however, it has become clear that the technique is associated with its own unique set of approach-related complications. An understanding of these complications and their potential causes is clearly critical for any surgeon attempting the technique.