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Minimally Disruptive Lateral Transpsoas Approach for Thoracolumbar Anterior Interbody Fusion

  • Dorcas Chomba
  • W. C. RodgersIII
  • W. B. RodgersEmail author
Chapter

Abstract

It has been 15 years since the commercial introduction of the lateral transpsoas interbody fusion procedure, utilizing a specialized retractor system and dedicated intervertebral implants paired with, most importantly, real-time surgeon-directed neuromonitoring integrated into instrumentation to allow for identification and avoidance of the nerves of the lumbar plexus. Since then, hundreds of thousands of lateral interbody fusions have been performed globally for an increasingly complex set of pathologies, with incremental technological innovation being introduced regularly. This mini-open approach can be successfully used in the treatment of thoracic disc herniations and advanced coronal and sagittal plane deformities, in the treatment of spinal trauma and tumors, as well as in the more “routine” and common short-segment degenerative lumbar spinal disease. However, successful adoption and use of this detail-oriented technique requires knowledge and understanding of the regional anatomy, careful review of and incorporation of axial magnetic resonance imaging findings into surgical decision-making, adherence to the canonical surgical technique, and adherence to neuromonitoring feedback. This chapter will cover the background, surgical technique, and best practices of the lateral transpsoas approach as they are currently understood, based on a vast amount of preclinical and clinical evidence as well as collective surgical experience.

Keywords

Lateral transpsoas interbody fusion Anterior to psoas approach Shallow docking Complications Outcomes Neural Alignment 

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Authors and Affiliations

  • Dorcas Chomba
    • 1
  • W. C. RodgersIII
    • 2
  • W. B. Rodgers
    • 3
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of NairobiNairobiKenya
  2. 2.Department of Mechanical Engineering and Materials ScienceYale UniversityNew HavenUSA
  3. 3.University of Quadra, Heriot BayCanada

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