Anterior paramedian retroperitoneal surgical approach to the lumbar spine

While routinely used in pediatric general surgery, the extraperitoneal paramedian approach to the spine and retroperitoneum has been employed infrequently in the adult population. We have utilized this technique successfully in 15 adult patients with pathologic conditions of the spine requiring radical vertebral body resection, dura decompression, and/or spine reconstruction. The anterior paramedian retroperitoneal dissection has definite advantages over the traditional transperitoneal or sympathectomy approaches. Wide exposure of the spine is obtained with minimal risk of contamination of the peritoneal cavity. Ease of orientation for identification of anatomic structures and radiographs is greatly enhanced.