Technical noteLateral lumbar retroperitoneal transpsoas approach in the setting of spondylodiscitis: A technical note

- The lateral approach is an increasingly more common approach for the treatment of lumbar osteomyelitis and osteodiscitis.
- Patients with Lumbar Osteodiscitis are often a frail population, warranting considerations to limit surgical invasiveness and blood loss.
- Lateral lumbar exposure bypasses the retroperitoneal great vessels, the adherence of which poses a significant risk for massive bleeding.
- While psoas abscesses are often inaccessible in a posterior approach, they can be safely drained by transpsoas surgery, avoiding CT guided drainage.

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 275 mL and 259 min, 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.