Abstract
The anterior retroperitoneal approach is a technique to treat disc degenerative disease (DDD), spinal deformities, traumas, tumors and infections. It can be used to perform Anterior Lumbar Interbody Fusions (ALIF) or Total Disc Replacements (TDR). Though being a fast procedure that is becoming more often used by spinal surgeons, the anterior approach requires an adequate knowledge of the anatomy of the abdomen to lessen the risks of intraoperative complications. The authors’ preferred technique is the left retroperitoneal video-assisted approach, using an endoscope to visualize and magnify the deep anatomical structures, discectomy procedure and hardware implant. In a review of our casuistry from 2010 to 2012, 163 patients underwent an anterior lumbar approach, and 139 of these had a single L4-5 or L5-S1 level treatment. A 3.6% rate of global complications (1.44% of major vascular injuries) has been observed, with a mean operation time of 116.4 minutes and a mean blood loss of 156.1 ml. These values show how the anterior retroperitoneal video-assisted approach for the treatment of lumbar diseases is a fast procedure that implies low blood loss, with a low rate of intraoperative complications.
Highlights
An anterior approach to the lumbar spine is often required in patients affected by chronic low back pain with or without radiculopathy, non-responsive to of conservative treatment for a period of at least 6 months
Degenerative disc disease (DDD), degenerative spondylolisthesis, lumbar stenosis with segmental instability, previous unsuccessful posterior lumbar surgery, non-union, restoration of disc height, spinal deformities, trauma or infections are the main indications for anterior lumbar approach
The anterior retroperitoneal approach allows the treatment of a wide range of pathologies affecting the lumbar spine, but can be a source of hazardous complications
Summary
An anterior approach to the lumbar spine is often required in patients affected by chronic low back pain with or without radiculopathy, non-responsive to of conservative treatment (medication, physical and pain therapy) for a period of at least 6 months. A good option for an anterior approach to the lumbar spine is the anterior retroperitoneal approach, useful to perform a lumbar interbody fusion (Anterior Lumbar Interbody Fusion, ALIF) or a Total Disc Replacement (TDR) [1] This approach is really minimal invasive for the patient, as the only incisions that are required are those of the skin, the fatty under skin layer and the fascia of the rectus muscles. In this paper we will describe the technique we personally use to perform the retroperitoneal anterior approach; it’s a video-assisted technique with the use of an endoscope This tool offers a good magnification and illumination of the surgical field, minimizing the incision and tissue damage and further increasing the precision of the surgery.
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