Mini-Open Anterior Retroperitoneal Approach

Abstract

Anterior lumbar interbody fusion was first described in 1932 by Capener and has been utilized for definitive treatment of spinal pathology (Capener, Br J Surg 19:374–386, 1932). The goal for the access surgeon is to provide adequate midline exposure to the lumbar spine so the spine surgeon can safely perform their intervention. The anterior retroperitoneal approach takes advantage of this space and can minimize potential complications seen with other approaches. This approach still requires manipulation of the peritoneal contents, ureter, and significant arterial and venous structures that could be injured. Increased understanding of spinal pathology and biomechanics, especially at the L5–S1 level, has made anterior spinal surgery appealing to many spine surgeons. The original exposure and morbidity of large incisions, significant blood loss, and operative time have also prevented some from adopting this approach. This chapter provides a detailed approach for a minimally invasive retroperitoneal exposure of the lumbar spine from L2 to S1.