Lateral lumbar retroperitoneal transpsoas approach in the setting of spondylodiscitis: A technical note.
Thoracolumbar spondylodiscitis is a morbid disease entity, impacting a sick patient population with multiple comorbidities. Wherever possible, surgical measures in this population should limit the extent of soft tissue disruption and overall morbidity that is often associated with anteroposterior thoracolumbar decompression and fusion. The authors describe the rationale, technique, and use of the lateral lumbar transpsoas retroperitoneal approach in tandem with posterior decompression and instrumented fusion in the treatment of circumferential thoracolumbar spondylodiscitis with or without epidural abscesses. The authors have routinely implemented the lateral lumbar transpsoas retroperitoneal approaches to address all pyogenic vertebral abscesses, spondylodiscitis, and ventral epidural abscesses with anterior column debridement and reconstruction with iliac crest autograft, posterior decompression, and pedicle screw instrumentation. In five consecutive patients, the mean blood loss and operative duration was 275mL and 259min, respectively. There were no instances of major vascular injury as this corridor obviates the need for retraction of inflamed retroperitoneal structures. The use of the lumbar lateral retroperitoneal transpsoas approach to the lumbar spine for the treatment of destructive and pyogenic spondylodiscitis is a potential alternative to the traditional anterior lumbar retroperitoneal approach in tandem with posterior spinal decompression and instrumented stabilization.
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
George M
GM
Ghobrial
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
Fadi
F
Al-Saiegh
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
Daniel
D
Franco
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
Daniel
D
Benito
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States. Electronic address: Joshua.heller@jefferson.edu.
Joshua
J
Heller
D000368:Aged; D019299:Decompression, Surgical / Q000379:methods; D015299:Discitis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D065289:Pedicle Screws; D016658:Psoas Muscles / Q000000981:diagnostic imaging / Q000601:surgery*; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D014182:Transplantation, Autologous / Q000379:methods
Epidural abscess; Lateral; Minimally invasive; Osteodiscitis; Spondylodiscitis; Transpsoas