Operative Technique and Literature Overview of the Lateral Access Surgery for Anterior Interbody Fusion

Abstract

Based on the concept of minimally invasive spinal surgery, the retroperitoneal lateral transpsoas access was developed to approach the lumbar spine in a less invasive way. This technique allows access to the intervertebral disc laterally through the fibers of the psoas muscle. This approach is reported to offer adequate disc exposure, with the benefit of reduced iatrogenic injury to abdominal great vessels, sympathetic plexus (reducing incidence of retrograde ejaculation), and neural structures. Here we minutely pass through the lateral interbody fusion technique, illustrate and highlight some hot points in the literature, while presenting clinical and radiological results and complications inherent to the technique. Similarly to other minimally invasive approaches, learning curve consist a real barrier to accomplish surgery objectives. So, complete knowledge of the steps and tricks are primordial to perform and evolve this procedure. Patient positioning regards to a critical point of the surgery, when truly perpendicular way to the level has to be set. Safe crossing of the psoas muscle is assured with intraoperative use of EMG, avoiding lumbar plexus and direct neural damage. Ipsilateral and contralateral annulus release provides cortical bone support to the interbody cage at apophyseal ring to prevent cage subsidence. The use of the lateral access has become popular and usual throughout the orthopedic and neurosurgery practice. However, as every incoming technology and technique, the users of it have to be attentive to its benefits and pitfalls.