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Retroperitoneal approach to the lumbar spine1

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Nitin Paikrao
Nitin Paikrao

The document summarizes the retroperitoneal approach to the lumbar spine. It describes the indications, patient positioning, incision details, and steps of the surgical dissection. These include splitting the external oblique, internal oblique, and transversus abdominis muscles to expose the retroperitoneal space. The peritoneum and its contents are then retracted to reveal the lumbar spine and vessels. The segmental vessels are ligated to provide access to the vertebral bodies after level confirmation with imaging. Care must be taken to avoid injury to nearby structures like the ureter and sympathetic chain during the procedure.

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RETROPERITONEAL APPROACH TO THE LUMBAR SPINE DR. ASHISH AGARWAL. DR.NITIN PAIKRAO. DEPT. OF ORTHOPAEDICS B.Y.L.NAIR CH. HOSPITAL
INDICATIONS FOR RETROPERITONEAL APPROCH l ,[object Object],[object Object],[object Object],[object Object],[object Object]
POSITION OF PATIENT ,[object Object],[object Object]
. ,[object Object],midline. Figure 6-31 Place the patient in the semilateral position for the anterolateral (retroperitoneal) approach to the lumbar
INCISION ,[object Object]
[object Object],posteriorly. Figure 6-33 Make an oblique flank incision extending down from the posterior half of the 12th rib toward the rectus abdominis muscle
SUPERFICIAL SURGICAL DISSECTION ,[object Object],[object Object]
[object Object],it. Figure 6-34 Incise the external oblique muscle and aponeurosis in line with its fibers and in line with the skin incision
. ,[object Object]
. ,[object Object]
[object Object],FIGURE 6-35 DIVIDE THE INTERNAL OBLIQUE IN LINE WITH THE SKIN INCISION AND PERPENDICULAR TO THE LINE OF ITS MUSCULAR FIBERS.
. ,[object Object]
. ,[object Object]
. ,[object Object],[object Object],[object Object],Figure 6-36 Divide the underlying transversus abdominis muscle in line with the skin incision.
DO NOT CUT TRANSVERSALIS FASCIA AS IT FORMS PROTECTIVE LAYER OVER THE PERITONEUM
. ,[object Object]
. ,[object Object],[object Object]
video
video
. ,[object Object]
video
. ,[object Object],[object Object]
. ,[object Object],[object Object]
. ,[object Object],[object Object]
IDENTIFY SEGMENTAL VESSEL TWO LAYERS OF PREVERTEBRAL FASCIA SEGMENTAL VESSELS IN BETWEEN
INFILTRATE PREVERTEBRAL FASCIA
video
INCISE ,[object Object],[object Object],[object Object]
DISSECTION OF SEGMENTAL VESSELS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SUBPERIOSTEAL DISSECTION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CAVEAT………… ,[object Object],[object Object],[object Object]
. ,[object Object],FRACTURE L2 VERTEBRA
 
[object Object],EXPANDIBLE CAGES
. ,[object Object]
L3 FRACTURE
L3 FRACTURE
 
 
L1 FRACTURE
L1 FRACTURE
 
 
[object Object],[object Object],[object Object],[object Object]
. ,[object Object]

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