Direct Lateral Transpsoas Lumbar Approach

Background Context: Spinal surgery has traditionally been described as morbid and painful.
Soft tissue disruption has been associated with changes in muscle function postoperatively. Lumbar spine fusion, due to the frequent occurrence of lumbar degenerative disc disease, is one of the more morbid procedures encountered in spine care today. Minimally invasive techniques have been developed in the hope of reducing this patient morbidity and subsequently improving outcomes. Direct lateral modification of the traditional open retroperitoneal approach is thought to be an advance in less traumatic techniques for approaching the mid-lumbar spine.

Purpose: Describe and discuss modification of the traditional open "Saber" retroperitoneal approach to the anterior column of the lumbar spine.

Study Design/Setting: Practice audit to review changes over time in surgical approach to the lumbar spine for degenerative conditions.

Methods: Literature and case review analysis over twenty-year scope of combined academic and private practice experience.

Results: Less invasive direct lateral transpsoas approach to the lumbar spine has proved to be an effective method of managing patients requiring interbody fusion of the mid-lumbar spine. Over a twenty-year period, modifications to the traditional open retroperitoneal approach have evolved into a less invasive direct lateral approach. This technique is augmented by means of improved intraoperative instrumentation, magnification and illumination.

Conclusions: Interbody fusion continues to provide a viable means of addressing degenerative changes of the anterior column in the lumbar spine. In an attempt to reduce patient morbidity and preserve the concept of anterior column support, the traditional lateral retroperitoneal approach to the lumbar spine has been modified. Modifications include the use of tubular retractors (solid or modular), intraoperative microscopes and fluoroscopy for a direct lateral approach to lateral lumbar interbody fusion. These modifications have advanced through an evolutionary process of improved technology allowing smaller incisions to accomplish equivalent, if not superior outcomes.