Falahee MH, Kahn EN, Heidenreich MJ, Aziz A, Springstead D, Malik RJ. Rapid, midline retroperitoneal exposure for four-level anterior lumbar interbody fusion-technical case atlas.
J Surg Case Rep 2021;
2021:rjab351. [PMID:
34408843 PMCID:
PMC8367439 DOI:
10.1093/jscr/rjab351]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022] Open
Abstract
We describe a novel, rapid midline retroperitoneal operative technique in a patient, with multi-level degenerative scoliosis, who underwent an extensive L2-S1 anterior lumbar interbody fusion in addition to posterior instrumentation. Uniquely, our approach enables an essentially midline approach to the rectus muscle and uses the diminution of the transversalis fascia-to-peritoneum transition in the pelvis to provide expedited exposure—making it particularly helpful for ALIF exposure, retraction and intraoperative radiography. We minimize morbidity around the rectus sheath by dissecting only the medial rectus muscle and then gently, bluntly mobilizing the retroperitoneum from the deep pelvis cranially.
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