Endoscopic retroperitoneal approach of the lumbar spine from L1 to L5

Anterior approach of the spine has many indications for fractures, deformities, degenerative deseases and metastases. Endoscopic Retroperitoneal approach of the lumbar spine needs to create the retroperitoneal space by CO2 insufflation or blade retractor for mini-open procedure. Left side is preferred to reach the spine. The psoas muscle is retracted posteriorly. After disc removal and disc height restauration, bone graft is packed in the disc space and one or two cages are inserted laterally. An additionnal plate fixation is recommended to increase stability. In burst fractures anterior bone graft is embended in the fracture after posterior reduction and fixation. The indications increase unbelievably since 4 years. Anterior endoscopic or video-assisted approach preserves posterior muscles, is less agressive and offers a better view on the spine. Retroperitoneoscopy [1, 17, 23] (RPS) is a recent technique using the principles of "endocavity surgery" in the retroperitoneal space to reach the lumbar spine from L1 to L5. We described this new approach in 1995 (12). Retroperitoneoscopy is used in urology for the dissection of the upper urinary tract (10, 20), and in vascular surgery for lumbar sympathectomies (5). The retroperitoneal space does not exist and it must be created (23). Then it must be maintained either by insufflation of carbon dioxide or by a special retractor, which is useful for video-assisted surgery. We shall describe the technique of the retroperitoneal approach before going on to give our indications and results.