The minimally invasive retroperitoneal transpsoas approach

Abstract

MIS spine surgeons have rapidly adopted the retroperitoneal transpsoas approach since its first introduction in 2001. Its use has been greatly expanded from simple indirect decompression from degenerative disc disease to complex spinal deformity correction and traumatic vertebral fractures. The technique offers a rapid approach to the disc space and availability of variety of large interbody grafts with excellent fusion rates whether used as stand-alone, with lateral plating, or with pedicle screw instrumentation for support. The advantage of using retroperitoneal transpsoas approach is faster operative time, less anesthesia to the patient, quicker recovery, and lower blood loss. However, thorough anatomical understanding of the surrounding lumbar plexus and meticulous technique must be observed to avoid potential serious complications. In this chapter we examine crucial surgical anatomy necessary for a successful outcome, provide detailed surgical technical notes, discuss surgical indications and patient selection, and finally review all potential complications and complication avoidance.