New percutaneous access method for minimally invasive anterior lumbosacral surgery.

Abstract: Preliminary cadaver, animal, and human studies wereperformed to determine the feasibility of axial anterior lumbosacralspine access using a percutaneous, presacral approach. Custom in-struments were directed under fluoroscopic guidance along the mid-line of the anterior sacrum to the surface of the sacral promontorywhere an axial bore was created into the lower lumbar vertebral bod-ies and discs. Imaging and gross dissection were performed in cadav-ers and animals. The procedure was used for lumbosacral biopsy inhuman subjects guided by intraoperative imaging and clinical moni-toring. All procedures were technically successful. This study dem-onstrates the feasibility of the axial access technique to the anteriorlower lumbar spine. Key Words: spine, percutaneous treatment, minimally invasive sur-gery, lumbar spine surgery( J Spinal Disord Tech 2004;17:21–28) T he common surgical approaches to the lumbosacral spineinvolve direct exposure to either the anterior or the poste-rior segments. These approaches require muscular and liga-mentous dissection, neural retraction, and annular disruption,occasionally with mobilization and retraction of vascular andvisceral structures. Complications associated with open spinalprocedures are vascular injury, sympathetic dysfunction,bowel injury, and neurologic deficit.