Introduction: The standard lateral retroperitoneal approach for lumbar fractures is usually performed by the general surgeon and involves extensive abdominal wall dissection and psoas muscle mobilization. We present our surgical technique and clinical experience with minimally invasive lateral retroperitoneal technique for lumbar corpectomy, in which the psoas muscle is dissected rather than mobilized.
Methods: A total of 21 patients presented with unstable lumbar traumatic fractures (L1, n=6; L2, n=7; L3, n=5; L4, n=3). Preoperative planning included computed tomography to determine the morphology of the fracture, magnetic resonance imaging to evaluate the trajectory of the femoral nerve in the psoas muscle (for L3 and L4 fractures), and lateral X-rays to determine the iliac crest height in rapport to the L4-5 disc (for L4 fractures). All patients underwent a minimally invasive transpsoas lumbar corpectomy, with or without direct decompression of the spinal canal, depending on the level of spinal canal compromise and neurological symptoms.
Results: The average operative time and estimated blood loss for the lateral corpectomy were 210 minutes and 400 ml, respectively. All patients underwent posterior fixation (one level above and one below) with bilateral pedicle screws and rods. Besides occasional thigh paresthesias, there were no complications related to this operation in any patient. All patients were mobilized postoperatively within 24 hours. At the 3- and 6-month follow-up visits, all patients were ambulatory and with no delayed complications from their spine operation.
Conclusions: We conclude that minimally invasive lateral transpsoas lumbar corpectomy is technically feasible and may provide quicker recovery and less morbidity.
Patient Care: Patients undergoing minimally invasive lateral corpectomy have less postoperative pain and can be mobilized faster.
Learning Objectives: 1. Understand the local anatomy for lateral minimally invasive lumbar corpectomy
2. Describe the individual challenges for the 4 lumbar levels that can be approached