Using a series of sequential selleck products dilators, the psoas is entered down to the center of the disc space. During this exposure, neuromonitoring is used to ensure the safety of the working channel. Discectomy and disc space preparation are then performed using standard techniques with a combination of pituitary rongeurs and ringed curettes under direct visualization. After complete preparation of the disc space, an intervertebral cage that spans the space with a wide aperture that is prefilled with bone graft is inserted into the disc space between the two end plates. The external oblique fascia, subcutaneous layer, and skin are then closed.Figure 2Two incision technique for a lateral transpsoas approach.

(a) Surgeon’s Finger traversing paraspinal muscle incision site, (b) finger identifying the retroperitoneal space, (c) surgeon’s finger guiding the first dilator onto the psoas major, and (d) dilator …4. Results and ComplicationsOne of the earliest series of patients that underwent a lateral approach was reported by Rodgers et al. in 2007 [17]. Indications for surgery were for various degenerative conditions. They reported the procedure was safe and reproducible with a low complication rate of 2% overall, with no major complications. Rodgers et al. noted a decrease in the VAS pain scores of 68%. In another series, Knight et al. in 2009 reported on 58 patients who underwent a lateral interbody arthrodesis for degenerative disc disease [23]. Compared to Rodgers et al, they reported longer operative times, mean of 161 minutes, and a higher complication rate, 22.4% overall.

Of the 13 patients who experienced complications, 9 of them were approach related with ipsilateral L4 nerve root injury in two cases, irritation of the lateral femoral cutaneous nerve in 6 patients and significant psoas muscle spasm that required extended hospitalization in two patient. Of the four other complications, three were medical and one was an acute subsidence of the implant. Rodgers et al. published another series on 100 patients who underwent XLIF for adjacent level degeneration adjacent to a prior spinal fusion surgery with similar improvement in VAS as their previous report. They reported nine complications for a total complication rate of 9%, with two patients each having postoperative urinary retention, cardiac complications, and ileus, one patient having transient tibialis anterior weakness that resolved in two weeks, one nonunion, and one vertebral body fracture.

Of note, one patient had transient thigh symptoms postoperatively, which they did not count as complications [18]. Berjano et al. recently published their results Brefeldin_A of 97 patients who underwent lateral interbody fusion for a variety of indications, most commonly degenerative disc disease in 78 patients [24].