Indirect decompression for lumbar spinal stenosis with the minimally invasive lateral approach

The lateral retroperitoneal approach is increasingly being utilized to achieve indirect decompression of the neural elements for symptomatic spinal stenosis. Early reports are promising as to the safety and efficacy, in particular for moderate stenosis in the mid-lumbar region. Correction of degenerative coronal deformities is possible, but sagittal alignment restoration is less reliable. There is a complication profile that is unique to this technique, and we are learning methods to minimize the incidence of approach-related thigh symptoms, lumbar plexus injuries, and abdominal wall bulging. Electrophysiological monitoring and a thorough knowledge of the anatomy are keys to safely performing the procedure.