Role of Neuromonitoring in Minimally Invasive Lateral Approaches to the Spine

Abstract

Minimally invasive approaches allow surgeons to achieve clinical outcomes similar to traditional open approaches but with decreased blood loss, postoperative pain, and length of hospital stay. In 1998, a minimally invasive retroperitoneal transpsoas approach to the lumbar spine was described that provided surgeon access to the anterior lumbar spine with less morbidity than that associated with the traditional retroperitoneal approach [1] while providing equivalent biomechanics [2]. In this procedure, the patient is typically placed in the right lateral decubitus position (so as to avoid the liver). Incisions are planned with the aid of fluoroscopy over the appropriate disc space(s) and the retroperitoneum is entered. The disc spaces are then sequentially accessed through the psoas muscle using a guidewire, dilators, and tubular retractor. Discectomy can then be performed, followed by placement of an interbody spacer. This procedure can be “stand alone” or supplemented with posterior instrumentation.