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Elias Dakwar, Rafael F. Cardona, Donald A. Smith and Juan S. Uribe

surgery are to obtain sagittal and coronal balance, pain relief, and solid fusion. 4 , 14 In many cases, these patients require treatment strategies that address both the anterior and posterior columns. An interbody graft placement allows for restoration of anterior column height, arthrodesis, and correction of the deformity. Anterior column support, by way of interbody graft placement, can be achieved using an anterior, posterior, or lateral approach. The minimally invasive, lateral retroperitoneal transpsoas approach allows for interbody graft placement and anterior

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Amir Ahmadian, Sean Verma, Gregory M. Mundis Jr., Rod J. Oskouian Jr., Donald A. Smith and Juan S. Uribe

to potentially mitigate approach-related risk and surgical morbidity. 1 , 22 , 23 , 26 Minimally invasive TLIF, mini-open TLIF/PLIF, and ALIF are common and effective techniques permitting direct decompression of neural elements, interbody fusion, and deformity correction through a single approach. However, these procedures still entail some degree of ligamentous and/or facet disruption. The lateral retroperitoneal transpsoas MIS-LIF has become an increasingly popular means of fusion because it avoids disruption of the posterior stabilizing elements of the spine

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Diana M. Molinares, Timothy T. Davis and Daniel A. Fung

oblique corridor to the lumbar spine based on MRI studies. The purpose of this study was to document the oblique corridor through MR image analysis, thus validating MRI as a means of presurgical planning for oblique lumbar interbody fusion. Methods One hundred thirty-three MR images of the lumbar spine obtained between May 4, 2012, and February 27, 2013, were randomly selected from our images database. Exclusion criteria consisted of previous lumbar or retroperitoneal surgery; there were no other exclusion criteria. One hundred thirty-three MR images were reviewed

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Joseph F. Simeone, Franklin Robinson, Stephen L. G. Rothman and C. Carl Jaffe

T wenty-eight cases of spontaneous retroperitoneal hemorrhage causing a femoral neuropathy have been reported in the English literature. 1 The diagnosis has, until now, been made on the basis of clinical signs and symptoms of a femoral neuropathy, and the knowledge that the patient has received anticoagulants. Occasionally barium enemas, intravenous pyelograms, and other diagnostic examinations have been employed to confirm the presence of a retroperitoneal mass. Two cases are reported in which computerized tomography (CT) demonstrated the presence of an

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Christopher E. Wolfla, Dennis J. Maiman, Frank J. Coufal and James R. Wallace

with a fusion rate in excess of 90%, and its use avoids the disadvantages associated with working through dense postoperative scarring as well as retraction of the thecal sac. Unfortunately, when undertaking traditional surgical exposures for the placement of instrumentation in these cases, the surgeon is forced to make difficult decisions when confronted with multilevel disease. Transabdominal and anterior retroperitoneal approaches provide excellent exposure of L-5 through S-1 and, depending on the level of the aortic bifurcation, L-4 through L-5 as well

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Ming Zhao, Xishan Li, Jianpeng Wang, Wang Li and Zilin Huang

retroperitoneal cavity. Also apparent is a circular, slightly high-density nodule (1.5 × 1.5 cm) in the left side of the lesion (arrows) , with delayed enhancement and surrounding unenhanced low-density areas ( A and B: arterial phase; C and D: venous phase). The mass was causing the pancreas to deviate toward the midline and was tightly adhering to the abdominal aorta and superior mesenteric artery, with the celiac trunk passing through the tumor, but did not infiltrate any of the surrounding organs. The lesion was evaluated in this patient, whose perioperative

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Akwasi Ofori Boah and Noel I. Perin

R etroperitoneal nerve sheath and paravertebral tumors are relatively rare entities, and their treatment may often involve a multidisciplinary surgical approach. 2 , 4–6 , 16 Traditionally, transabdominal and retroperitoneal approaches have been employed for the treatment of these lesions. Less invasive techniques, such as laparoscopy 3 , 10 , 11 , 13 (including robot-assisted laparoscopy), 7 , 18 CyberKnife radiosurgery, 8 and CT-guided radiofrequency ablation 19 have also been noted as treatment options. Traditional approaches are associated with

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Shigeki Kubo, Masato Ueno, Hiroshi Takimoto, Jun Karasawa, Amami Kato and Toshiki Yoshimine

with previous abdominal surgery, adhesion of the anterior peritoneum may cause problems for peritoneal catheter insertion during laparotomy. To address these problems, we developed a method for retroperitoneal placement of the LP shunt. Shunt Placement Method After induction of general anesthesia, the patient is placed in the lateral decubitus position with the left flank upward. A bolster is placed under the right flank to stretch the left flank between the 12th rib and iliac crest. A 2-cm-long lumbodorsal incision is made in the region between the external

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Manfred Mühlbauer, Wolfgang Pfisterer, Richard Eyb and Engelbert Knosp

T he effectiveness of anterior decompression and spinal fusion for the treatment of patients with thoracolumbar fractures and spinal tumors is well documented in the literature. 2, 10, 12, 16, 18, 25–27 However, the conventional retroperitoneal approach for lumbar spinal fusion, as described in the literature, is a very invasive procedure that causes considerable trauma to tissue just to gain access to the desired surgical target area. 3, 8, 24 In cases of single-level anterior lumbar interbody fusion, several minimally invasive techniques (for instance, the

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Yong Ahn, Jin Uk Kim, Byung Hoi Lee, Sang-Ho Lee, Jong Dae Park, Dong Hyun Hong and June Ho Lee

intraabdominal structures to the opposite side ( Fig. 1B and C ). The patient was transferred to the intensive care unit ICU and received packed red blood cells and platelet concentrate as needed. After the blood profile and vital signs became stable, a careful open retroperitoneal exploration for hematoma debulking was performed by the general surgeons as the patient's pain did not improve over time. Thereafter, the patient's pain and discomfort abated again. Postoperative Course On the follow-up abdominal CT scan obtained 5 days later, there was no evidence of delayed