[Transmuscular approach (XLIF technique) for anterior surgery of the lumbar spine].

OBJECTIVE: Anterior stabilization of the spine with a lateral approach to insert a large and broad cage creating a better bearing surface to restore or maintain the lumbar lordosis.

INDICATIONS: Degenerative scoliosis as well as revision surgery for stenosis of the neuroforamen. Lumbar corpectomies between L2/3 and L4/5 can be approached as well.

CONTRAINDICATIONS: The segment L5/S1 is not suitable for the transmuscular approach. Relative contraindications are previous retroperitoneal surgery and spondylolisthesis with sliding of more than 50% (> Meyerding 2) SURGICAL TECHNIQUE: We describe the transmuscular retroperitoneal approach to the lumbar segments which is called extreme lateral approach (XLIF). To protect the spinal nerves on the way through the psoas muscle, use of intraoperative triggered neuromonitoring is paramount.

POSTOPERATIVE MANAGEMENT: Full mobilization directly after surgery is possible in most cases. Weight bearing should be restricted to 20 kg for 3 months after surgery.

RESULTS: The transmuscular approach to the lumbar spine is a good alternative to reach the anterior part of the lumbar spine. Degenerative scoliosis as well as stenosis of the neuroforamen especially in revision surgery are good indications for this technique. Injuries of the spinal nerves range from 0.7 to 15%. Other complications are rare.