EXTRAPERITONEAL APPROACH TO THE LUMBAR SPINE WITH VIDEO ASSISTANCE

Study Design. Description of a new operative technique for anterior lu mbar and lumbosacral fusion using an anterior extraperitoneal approach optimized by video assistance. Objectives. To propose a less invasive technique for anterior lumbar fusion with low-grade morbidity. Summar y of Background Data. Either anterior trans-peritoneal or anterolatera l extraperitoneal approaches commonly are performed, but each involves specific drawbacks. The authors attempted to modify and simplify thes e approaches with the addition of retroperitonoscopy. Methods. A small , vertical 4- to 5-cm incision is made on the midline, centered on the umbilicus for the L4-L5 approach and halfway between umbilicus and pu bic symphysis for the L5-S1 approach. The peritoneum is dissected from the left abdominal wall, and the anterior aspect of the spine progres sively is exposed. The endoscope is introduced laterally, providing ex cellent visualization of the prevertebral area. A specially designed r etractor allows retraction of the iliac vessels. Results. A midline an terior approach allows disc resection and grafting in a strict midline position. The extraperitoneal approach simplifies the postoperative c ourse. Video assistance permits an approach to the spine by a short in cision and facilitates the prevertebral dissection. Surgery with video assistance should be differentiated from true endoscopic surgery, whi ch ids performed under CO2 insufflation with exclusive endoscopic visi on. Conclusions. Video assistance allows for an anterior extraperitone al approach to the lumbar spine and has the potential for lower morbid ity, increasing the possibilities of anterior fusion in the management of lumber disc disease.