[Modified anteriolateral retroperitoneal approach for surgical treatment of patients with compression of the cauda equina and lumbar nerve roots (topographic anatomical study)].

Mini-invasive techniques have been increasingly used in lumbar surgery in the past decade, most commonly during operations on the intervertebral disks. However, mini-invasive interventions may be used as a modified traditional approach to treating more serious and challenging pathology, such as tumors of the lumbar vertebrae, metastatic disease, as well as lumbar fractures of different origin. In the literature, there are only several papers on the mini-invasive anterolateral retroperitoneal approach (ALMIRA) to corpectomy with repair of the lumbar spine. This paper deals with the autopsy of 15 cadavers (aged 55-83 years) and 5 blocks of the lumbar spine. The approach is described with illustrations being given. All the results are analyzed and shown in a table. Fifteen corpectomies of L2, L3, and L4 vertebrae were performed by ALMURA, using a self-retaining retractor. The duration of a procedure from skin incision to complete preparation of a spinal specimen for retractor's attachment averaged 50 min (30-70 min). The corpses were rotated in the axial plane at 45, 35, and 25 degrees for corpectomy of L2, L3, L4, respectively. The procedure was easier-to-use when convex binding of the spine was performed after the approach and before insertion of a retractor, in obese cases in particular. Damage to the peritoneum occurred in 5 cases, that to the ascending lumbar vein took place in 4 (during L4 corpectomy) and m. psoas in 2 cases, both in a cachectic cadaver. In the authors' opinion, the method is effective, but before applying it in the clinical theater, spinal surgeons should be well trained under experimental conditions.