Lumbar Interbody Fusion for Adjacent Segment Disease: An illustrative Case of The Retroperitoneal Anterolateral Psoas-Sparing Approach (Antepsoas; ATP)

Abstract

Following prior lumbar arthrodesis, surgery for adjacent segment disease (ASD) is not uncommon. Many challenges exist due to scarring, laminectomy defects, retained hardware, and increased risks of various surgical morbidities. These include iatrogenic durotomy, neurologic injuries, wound infections, and ASD recurrence. The minimally invasive retroperitoneal anterolateral psoas-sparing (ATP) approach, unlike the transpsoas and transforaminal techniques, allows access to the T12-S1 segments, enabling unobstructed corridor to discectomy, endplate preparation, anterior column release, direct lumbar decompression, intervertebral height restoration, and sagittal lordosis correction. Despite the promising attributes of the ATP in managing ASD, high quality data is still lacking.