Abstract

Minimally invasive approaches to the lumbar spine continue to evolve in a quest to reduce approach-related morbidity. The lateral trans-psoas approaches are accepted as a safe and reliable technique through much of the lower spine, but cannot currently be performed at L5-S1 due to the iliac crest. Now, we propose that the trans-sacral approach allows a novel minimally invasive technique to access L5-S1. Additionally, the ribs used to be feared as a barrier to the lateral approach, but we will show that one can now safely perform the same lateral interbody fusion working in between the ribs working all the way up to the lower thoracic spine. Lastly, pedicle screw instrumentation is no longer a barrier in long segment instrumentation thanks to better developed percutaneous pedicle screw and rod delivery systems. We will describe these techniques used in combination to tackle multilevel cases including from the lower thoracic spine down to the sacral spine including adult degenerative scoliosis.