Study Design:

Retrospective clinical study. Objective: This study aimed to compare the cosmetic and functional outcomes of the patients undergoing anterior and posterior combined surgery via either anterior paramedian or anterolateral retroperitoneal approach.

Summary of Background Data:

Exposure of the anterior portion of the lumbar disks can be obtained through either a transperitoneal or extraperitoneal approach, utilizing a variety of skin incisions. The retroperitoneal approach is the preferred procedure because it can be performed through small skin incisions and obviates the need for bowel retraction.

Methods:

The study reviewed 41 patients with lumbar spinal stenosis surgically treated by combined anterior and posterior routes. In addition to posterior instrumentation, decompression and fusion; anterolateral retroperitoneal approach was performed in 14 patients (Group 1) and anterior paramedian retroperitoneal approach was done in 27 patients (Group 2) for anterior interbody fusion. An access surgeon was used in all cases.

Results:

The mean postoperative SRS score was 22.4 for anterolateral approach and 24.2 for anterior paramedian approach (P < 0.05). The largest difference was observed in self-image and pain control items of SRS questionaire and there was no difference observed in function and daily activities. There were 4 patients having wound problems in group1 whereas this number was 1 in group 2. All these patients were recovered by local wound debridement and primary closure. There were 5 patients developing abdominal swelling in anterolateral approach regarded as abdominal herniation.

Conclusion:

The anterior and anterolateral surgical approaches to the lumbar spine can be used safely if the surgeon is familiar with the anatomy and is aware of potential complications. Patients undergoing anterior paramedian approach to lumbar spine have higher quality of life and cosmetic outcomes compared with patients having anterolateral retroperitoneal approach.

Keywords: Anterior interbody fusion, Anterior paramedian retroperitoneal approach, Anterolateral retroperitoneal approach, Cosmesis.