The Anterior Retroperitoneal Approach to the Degenerative Lumbar Spine: Clinico-Therapeutic Remarks

The anterior approach is a well-known surgical technique for the treatment of degenerative diseases of the lumbar spine. Through this approach is possible to perform arthrodesis, arthroplasty, discectomy, corpectomy to treat a lot of degenerative conditions. The ALIF procedure is one of the most widely used technique, and is argued to have biomechanical advantages over posterior approaches for lumbar spinal fusion: restoration of disk height and lumbar lordosis, reduction of listhesis, restoring of coronal and sagittal balance. Through this approach is also possible to perform a lumbar disc arthroplasty, a motion preservation technique which aim is to restore the biomechanical properties of the lumbar spinal motor unit. Moreover, in a more recent period, a lot of alternative anterior approaches are described and used, such as Extreme Lateral trans-psoas approach (the XLIF technique). In the current clinical practice, anterior approaches seem to play an extremely important role for the management of lumbar degenerative diseases. In this editorial we want to describe systematically the classic anterior approach, highlighting advantages and disadvantages of the surgical technique and related complications based on personal experience and literature review. Aim of this article is to provide an updated window on the surgical technique for the anterior retroperitoneal approach, frequently used for the treatment of degenerative pathology of the lumbar spine.