Retroperitoneal Approach to the Lumbar Spine: A Case-Based Approach for Primary Tumor

  • Étienne Bourassa-Moreau
  • Joel Gagnon
  • Charles G. FisherEmail author


Primary spinal tumors are rare, challenging to diagnose, and require multidisciplinary management to provide appropriate care. The treatment selection is based on the histological grade of the tumor, its local extension, and the presence of metastasis. When surgical resection is needed, thorough planning is mandatory to achieve treatment goals, especially in the case of en bloc resection.

In many cases, an anterior lumbar retroperitoneal approach is essential to achieve appropriate oncological margins. Critical vascular, urological, and neurological structures lie in close proximity to the anterior lumbar spine. Complications associated with the anterior retroperitoneal approach should be anticipated with preventive measures and addressed in a timely fashion. Therefore, the spinal surgeon should be familiar with the retroperitoneum anatomy and its relationship to the tumor being treated. A case of an L4 chondrosarcoma illustrates the planning and execution of the anterior retroperitoneal approach to achieve a curative resection.


Primary tumor Spine Surgery Anterior approach Surgical planning Enneking classification Lumbar spine Retroperitoneal WBB Weinstein-Boriani-Biagini En bloc 


  1. 1.
    Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980;153:106–20.Google Scholar
  2. 2.
    Fisher CG, Saravanja DD, Dvorak MF, Rampersaud YR, Clarkson PW, Hurlbert J, et al. Surgical management of primary bone tumors of the spine: validation of an approach to enhance cure and reduce local recurrence. Spine (Phila Pa 1976). 2011;36(10):830–6.CrossRefGoogle Scholar
  3. 3.
    Brau SA. Mini-open approach to the spine for anterior lumbar interbody fusion: description of the procedure, results and complications. Spine J. 2002;2(3):216–23.CrossRefGoogle Scholar
  4. 4.
    Feigl GC, Dreu M, Ulz H, Breschan C, Maier C, Likar R. Susceptibility of the genitofemoral and lateral femoral cutaneous nerves to complications from lumbar sympathetic blocks: is there a morphological reason? Br J Anaesth. 2014;112(6):1098–104.CrossRefGoogle Scholar
  5. 5.
    Feigl GC, Kastner M, Ulz H, Breschan C, Dreu M, Likar R. Topography of the lumbar sympathetic trunk in normal lumbar spines and spines with spondylophytes. Br J Anaesth. 2011;106(2):260–5.CrossRefGoogle Scholar
  6. 6.
    Bjurlin MA, Rousseau LA, Vidal PP, Hollowell CM. Iatrogenic ureteral injury secondary to a thoracolumbar lateral revision instrumentation and fusion. Spine J. 2009;9(6):e13–5.CrossRefGoogle Scholar
  7. 7.
    Isiklar ZU, Lindsey RW, Coburn M. Ureteral injury after anterior lumbar interbody fusion. A case report. Spine (Phila Pa 1976). 1996;21(20):2379–82.CrossRefGoogle Scholar
  8. 8.
    Rothenfluh DA, Koenig M, Stokes OM, Behrbalk E, Boszczyk BM. Access-related complications in anterior lumbar surgery in patients over 60 years of age. Eur Spine J. 2014;23(Suppl 1):S86–92.CrossRefGoogle Scholar
  9. 9.
    Nalbandian MM, Hoashi JS, Errico TJ. Variations in the iliolumbar vein during the anterior approach for spinal procedures. Spine (Phila Pa 1976). 2013;38(8):E445–50.CrossRefGoogle Scholar
  10. 10.
    Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries: incidence and morphometry. Surg Radiol Anat. 2001;23(1):33–8.CrossRefGoogle Scholar
  11. 11.
    Amendola L, Cappuccio M, De Iure F, Bandiera S, Gasbarrini A, Boriani S. En bloc resections for primary spinal tumors in 20 years of experience: effectiveness and safety. Spine J. 2014;14(11):2608–17.CrossRefGoogle Scholar
  12. 12.
    Boriani S, Gasbarrini A, Bandiera S, Ghermandi R, Lador R. En bloc resections in the spine: the experience of 220 patients during 25 years. World Neurosurg. 2017;98:217–29.CrossRefGoogle Scholar
  13. 13.
    Brau SA, Delamarter RB, Schiffman ML, Williams LA, Watkins RG. Vascular injury during anterior lumbar surgery. Spine J. 2004;4(4):409–12.CrossRefGoogle Scholar
  14. 14.
    Maher ER, Yates JR, Harries R, Benjamin C, Harris R, Moore AT, et al. Clinical features and natural history of von Hippel-Lindau disease. Q J Med. 1990;77(283):1151–63.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Étienne Bourassa-Moreau
    • 1
  • Joel Gagnon
    • 2
  • Charles G. Fisher
    • 3
    Email author
  1. 1.Hôpital du Sacré-Coeur de Montréal, Department of Orthopaedic SurgeryMontrealCanada
  2. 2.Vancouver General Hospital, Department of Vascular SurgeryVancouverCanada
  3. 3.Vancouver General Hospital, Department of Orthopaedics, Division of SpineVancouverCanada

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