Anterior-Posterior Surgeries

Combined anterior and posterior approaches to the lumbar spine have several indications depending on the underlying pathology, but are often employed for debilitating sagittal imbalance and spinopelvic malalignment insufficiently addressed by a single approach. In such cases, the benefits of anterior column release, segmental lordosis correction, and disc space reconstruction are matched by posterior realignment (i.e., osteotomies) and superior instrumented arthrodesis. The anterior retroperitoneal approach is preferred over transperitoneal, because of lower rates of ileus and sympathetic hypogastric plexus stretch injury and improved intervertebral disc-space access. Posterior osteotomies of varying extents may be utilized for rigid deformity correction but must be closed carefully to minimize iatrogenic neural compromise. The combined approach is ideal for circumferential decompression, substantial spinal realignment, and stabilization, but requires careful patient selection.