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

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 essentiallymidline approach to the rectusmuscle and uses the diminution of the transversalis fascia-Toperitoneum transition in the pelvis to provide expedited exposure making it particularly helpful for ALIF exposure, retraction and intraoperative radiography.Weminimizemorbidity around the rectus sheath by dissecting only the medial rectusmuscle and then gently, bluntly mobilizing the retroperitoneum from the deep pelvis cranially.