Rapid, midline retroperitoneal exposure for four-level anterior lumbar interbody fusion-technical case atlas

August 20, 2021

. 2021 Aug 16;2021(8):rjab351.

doi: 10.1093/jscr/rjab351.

eCollection 2021 Aug.

Affiliations

Item in Clipboard

Mark H Falahee et al.

J Surg Case Rep.

2021.

Abstract

We describe a novel, rapid midline retroperitoneal operative technique in a patient, with multi-level degenerative scoliosis, who underwent an extensive L2-S1 anterior lumbar interbody fusion in addition to posterior instrumentation. Uniquely, our approach enables an essentially midline approach to the rectus muscle and uses the diminution of the transversalis fascia-to-peritoneum transition in the pelvis to provide expedited exposure-making it particularly helpful for ALIF exposure, retraction and intraoperative radiography. We minimize morbidity around the rectus sheath by dissecting only the medial rectus muscle and then gently, bluntly mobilizing the retroperitoneum from the deep pelvis cranially.

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2021.

Figures

**Figure 1**

Posterior rectus sheath exposure through a midline approach.

**Figure 2**

Mobilization of the peritoneal cavity and accessing the retroperitoneum.

**Figure 3**

Division of iliolumbar, lumbar and median sacral vessels; exposure of L5-S1.

**Figure 4**

Mobilization of the aorta and IVC with exposure of the spine.

**Figure 5**

Intraoperative anterior lumbar interbody fusion L2-S1; solid black arrow, top: aorta; solid black arrows, bottom: right and left common iliac arteries; solid white arrow, top: Inferior vena cava; solid white arrow, bottom: left common iliac vein

References

1. Ito H, Tsuchiya J, Asami G. A new radical operation for Pott’s disease. J Bone Joint Surg 1934;16:499–515.
1. Ferguson SJ, Steffen T. Biomechanics of the aging spine. In: Aebi M, Gunzburg R, Szpalski M (eds). The Aging Spine. Berlin, Heidelberg: Springer, 2005.
1. Chiriano J, Abou-Zamzam AM, Zhang UO, Cheng Wayne WW. The role of the vascular surgeon in anterior retroperitoneal spine exposure: preservation of open surgical training. J Vasc Surg 2009;50:148–51.
  
  –
  
  PubMed
1. Zahradnik V, Lubelski D, Abdullah K, Kelso R, Mroz T, Kashyap V. Vascular injuries during anterior exposure of the thoracolumbar spine. Ann Vasc Surg 2013;27:306–13.
  
  –
  
  PubMed
1. Garg J, Woo K, Hirsch J, Bruffey J, Dilley R. Vascular complications of exposure for anterior lumbar interbody fusion. J Vasc Surg 2010;51:946–50.
  
  –
  
  PubMed