The Minimally Invasive Retroperitoneal Transpsoas Approach

Minimally invasive spine surgery has evolved from traditional open spine surgery, and it is an accepted, safe alternative (McAfee, et al., 2010). Traditional open operations for lumbar interbody fusion include anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF). The ALIF provides for a large interbody graft for disc space re-expansion, restoration of lumbar lordosis, and elimination of discogenic pain (Hodgson & Stock, 1956). In addition, posterior facet joint complexes and tension bands remain intact. However, an access surgeon may be needed, and complications can include a risk of vascular injury and also rare iatrogenic retrograde ejaculation in males postoperatively. The TLIF (Harms & Rolinger, 1982; Harms & Jeszenszky, 1998) was developed as a modification of the PLIF (Cloward, 1953) to decrease the degree of nerve root and thecal sac manipulation, and it allows for interbody fusion, concurrent posterior segmental instrumentation, and circumferential fusion. It can be performed either in an open or minimally invasive manner. The graft size is typically smaller than that of the ALIF, however.