Lateral Trans-Psoas Approach to Fix the Lumbar Spine

The present study describes a new surgical approach to fix the lumbar spine with evaluation of the prospective early outcome. In the period from October 2004 to January 2006, 10 patients with degenerative spondylolisthesis (7 females, 3 males; mean age 43.0 year) underwent lateral retroperitoneal trans-psoas approach for screws and plate fixation of the lumbar spine. All cases (2 with prior posterior surgery and 8 without) had instability at one level which was L3-4 in 2 patients and L4-5 in 8. Spinal stenosis, large disc protrusion, and L5-S1 instability were excluded from this study. Average operative time was 3.2 hours; average blood loss was 450CC, and average postoperative hospital stay was 4.3 days. Clinical and radiological outcome after one year follow-up were satisfactory in the 10 patients. Neither mortality nor massive blood loss were encountered. Complications were in the form of temporary weak painful left hip flexion in all the patients, transient ileus in 4, inadvertent lumber sympathectomy in 2, incisional hernia in 1, and mild wound infection in 1.