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Related Experiment Video

Updated: Sep 25, 2025

Three-dimensional Navigation-guided, Prone, Single-position, Lateral Lumbar Interbody Fusion Technique
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Endoscope-Assisted Retroperitoneal Prepsoas Approach to Lumbar Intervertebral Disk Decompression. Technical Note.

Gordon Mao1,2, Zach Pennington1,3, Ann Liu1

  • 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Operative Neurosurgery (Hagerstown, Md.)
|April 29, 2022
PubMed
Summary

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Endoscope-assisted retroperitoneal prepsoas lumbar diskectomy offers effective decompression. This minimally invasive technique shows promise for expanding surgical options in treating lumbar spine pathologies.

Area of Science:

  • Minimally Invasive Spine Surgery
  • Spinal Anatomy and Biomechanics
  • Surgical Endoscopy

Background:

  • Growing demand for minimally invasive surgical techniques to treat spinal conditions.
  • Retroperitoneal prepsoas and transpsoas approaches are gaining traction for lumbar spine access.
  • Endoscopic assistance may further minimize soft tissue disruption during these procedures.

Purpose of the Study:

  • To detail an endoscope-assisted lateral retroperitoneal prepsoas approach for performing lumbar diskectomy.
  • To evaluate the feasibility and effectiveness of this minimally invasive technique.

Main Methods:

  • Utilized two fresh-frozen thoracolumbar cadaveric specimens in the right lateral decubitus position.
  • Performed diskectomies at L2/3, L3/4, L4/5, and L5/S1 using a left-sided retroperitoneal prepsoas approach under endoscopic visualization.

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  • Qualitatively assessed the extent of central and contralateral foraminal decompression.

    • Main Results:

    • Endoscopic visualization proved effective across all tested lumbar intervertebral spaces.
    • The combined approach facilitated effective decompression of all evaluated disk spaces.
    • While ipsilateral foramen visualization was challenging, adequate decompression was achieved for central, paracentral, and contralateral far lateral disk herniations.

    Conclusions:

    • Endoscope assistance enhances visualization during retroperitoneal prepsoas lumbar approaches.
    • This technique may broaden the indications for anterior and oblique lumbar interbody fusion procedures.
    • Minimally invasive endoscopic techniques represent a promising advancement in lumbar spine surgery.