Video-Assisted Anterior Retroperitoneal Approach to the Lumbar Spine. A Minimal Invasive Technique Improved by the Use of Endoscopic Camera to Treat Lumbar Spine Diseases

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.