title: [Minimal invasive anterior midline approach to L2-L5].
abstract: OBJECTIVE
  To describe a minimally invasive midline approach, retroperitoneal or transperitoneal, to the lumbar spinal levels L2-L5.
  
  
  METHODS
  Degenerative disc disease (DDD) with or without disc herniation that may require a total lumbar disc replacement; also for fusion-cases like degenerative instability, tumors, isthmic and degenerative spondylolisthesis of all grades (after dorsal reduction), fractures, spondylodiscitis, failed back syndrome (pseudarthrosis, post-discectomy)
  
  
  METHODS
  Relative contraindications are previous abdominal surgeries; aortic bifurcation and/or venous confluens directly in front of the disc space L4/5; infections with the formation of a large prevertebral granulation tissue or psoas abscess; adipositas permagna.
  
  
  METHODS
  Anterior midline incision over the relevant disc space with a left retro- or transperitoneal approach. Transperitoneal approach: mini laparatomy with dissection of the peritoneum and mobilization of the bowels laterally; retroperitoneal mobilization of the peritoneal sac towards the contralateral side; preparation of the anterolateral circumference of the disc space and mobilization of adjacent vessels depending on the vessel anatomy; discectomy and preparation of the graft bed.
  
  
  METHODS
  Early mobilisation from the first postoperative day for combined ALIF/posterior instrumentation procedures. Thromboembolic prophylaxis with fractioned heparin. Light meals up until recovery of bowel activities. No brace is needed for total lumbar disc replacement procedures. A brace is recommended depending on the type of intervention (fusion) for a duration of up to 12 weeks. No limitations for standing, walking or sitting in the immediate postoperative period.
  
  
  RESULTS
  A minimally invasive midline approach was performed in 686 patients (19-84 years; 94-320 pounds). In 444 cases the levels L2-L5 were exposed. The average time of exposure to these levels was 22.7 minutes. 6 months postoperatively the approach related complications were evaluated. A total of 3.8% major complications were observed overall.
authors.affiliation: Wirbelsäulenzentrum Starnberger See, Benedictus Krankenhaus Tuzting, Tutzing, Germany. cmehren@gmx.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Mehren
authors.forename: Andreas
authors.initials: A
authors.lastname: Korge
authors.forename: Christoph
authors.initials: C
authors.lastname: Siepe
authors.forename: Frank
authors.initials: F
authors.lastname: Grochulla
authors.forename: H Michael
authors.initials: HM
authors.lastname: Mayer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000601:surgery*