{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:05:11Z","timestamp":1780131911746,"version":"3.54.0"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,8]]},"abstract":"\n Object<\/jats:title>\n The medical management of discitis and osteomyelitis with long-term antibiotic therapy and bracing usually results in eradicated infection. Surgical management is appropriate when medical management fails and in some cases with pyogenic deformity or neurological deficit. The success of surgery depends on adequate debridement of the necrotic infected disc and vertebral body, along with anterior column reconstruction and vertebral stabilization. Debridement is typically performed via an anterior retroperitoneal approach, which can necessitate mobilization of the great vessels for proper exposure. Mobilization can be technically difficult and lead to vascular injury. The purpose of this study was to evaluate an alternative technique for the surgical treatment of lumbar discitis and osteomyelitis using a direct lateral retroperitoneal approach, which allows for thorough debridement and anterior column reconstruction while avoiding the need to mobilize the great vessels.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective chart analysis was performed for all patients who had presented with lumbar discitis and osteomyelitis and had undergone surgical management via the direct lateral retroperitoneal approach in the period from 2006 to 2013. Collected data included surgical blood loss, perioperative complications (wound infection, vascular injury, approach-related complications, and neurological injury), need for secondary procedures, microbiological and laboratory results, and efficacy of infection eradication. Imaging studies were reviewed as well.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Ten patients, 7 male and 3 female, underwent this procedure at the authors' institution in the defined period. Average blood loss was 272 ml (range 150\u2013800 ml, with 800 ml in the only 2-level case). There were no vascular injuries. Average follow-up was 680 days, although 4 patients did not complete the follow-up beyond 6 months. Eight patients underwent immediate posterior pedicle screw instrumentation. Two patients did not undergo posterior instrumentation, and one of these developed a kyphotic deformity that required a secondary posterior procedure. Infection was eradicated in all patients according to a history, physical examination, imaging studies, and laboratory parameters (complete blood count, erythrocyte sedimentation rate, and C-reactive protein). One patient developed a painful neuroma at the iliac crest harvest site, and one patient had a retroperitoneal hematoma. Otherwise, there were no approach-related neurological injuries or complications. Neither was there any postoperative surgical site infection.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The direct lateral approach for the surgical treatment of lumbar discitis and osteomyelitis allows for thorough debridement and spinal reconstruction without the need to mobilize the great vessels. This technique effectively eradicated infection in all cases, with reasonable blood loss and no vascular injuries. This approach should be considered as an alternative to the open anterior approach. The authors recommend posterior instrumentation to prevent the development of kyphosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2014.6.focus14150","type":"journal-article","created":{"date-parts":[[2014,8,1]],"date-time":"2014-08-01T03:47:18Z","timestamp":1406864838000},"page":"E5","source":"Crossref","is-referenced-by-count":28,"title":["Direct lateral retroperitoneal approach for the surgical treatment of lumbar discitis and osteomyelitis"],"prefix":"10.3171","volume":"37","author":[{"given":"Karthik","family":"Madhavan","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Vanni","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth K.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus14150","series-title":"Nat Rev Nephrol","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1038\/nrneph.2011.105","article-title":"Spondylodiscitis in a patient on chronic hemodialysis","volume":"7","author":"Afshar","year":"2011"},{"key":"b2-focus14150","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2227","DOI":"10.1097\/00007632-199311000-00014","article-title":"Vascular injury in anterior lumbar surgery","volume":"18","author":"Baker","year":"1993"},{"key":"b3-focus14150","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E687","DOI":"10.1097\/BRS.0b013e3181ec5911","article-title":"Anatomic mapping of lumbar nerve roots during a direct lateral transpsoas approach to the spine: a cadaveric study","volume":"36","author":"Banagan","year":"2011"},{"key":"b4-focus14150","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"139","DOI":"10.3171\/2008.10.SPI08479","article-title":"An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine. Laboratory investigation","volume":"10","author":"Benglis","year":"2009"},{"issue":"Suppl 1","key":"b5-focus14150","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"S37","DOI":"10.1007\/s00586-012-2217-z","article-title":"Direct lateral access lumbar and thoracolumbar fusion: preliminary results","volume":"21","author":"Berjano","year":"2012"},{"key":"b6-focus14150","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1016\/j.spinee.2011.07.020","article-title":"Vertebral body fractures after transpsoas interbody fusion procedures","volume":"11","author":"Brier-Jones","year":"2011"},{"key":"b7-focus14150","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2695","DOI":"10.1097\/01.brs.0000244662.78725.37","article-title":"Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center","volume":"31","author":"Butler","year":"2006"},{"key":"b8-focus14150","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"227","DOI":"10.3171\/2012.5.SPINE1288","article-title":"Motor nerve injuries following the minimally invasive lateral transpsoas approach. Clinical article","volume":"17","author":"Cahill","year":"2012"},{"issue":"26 Suppl","key":"b9-focus14150","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S361","DOI":"10.1097\/BRS.0b013e318202308b","article-title":"Biomechanical analysis and review of lateral lumbar fusion constructs","volume":"35","author":"Cappuccino","year":"2010"},{"key":"b10-focus14150","series-title":"Int Orthop","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1007\/s002640050145","article-title":"Retrograde ejaculation after retroperitoneal lower lumbar interbody fusion","volume":"21","author":"Christensen","year":"1997"},{"key":"b11-focus14150","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2751","DOI":"10.1097\/BRS.0b013e31815a996e","article-title":"Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management","volume":"32","author":"Fantini","year":"2007"},{"key":"b12-focus14150","series-title":"Am J Surg","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.amjsurg.2006.08.085","article-title":"Open anterior approaches for lumbar spine procedures","volume":"194","author":"Gumbs","year":"2007"},{"key":"b13-focus14150","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/j.spinee.2006.05.015","article-title":"Revision open anterior approaches for spine procedures","volume":"7","author":"Gumbs","year":"2007"},{"issue":"3 Suppl","key":"b14-focus14150","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1227\/01.NEU.0000324520.95150.4C","article-title":"The history of spinal deformity","volume":"63","author":"Heary","year":"2008"},{"key":"b15-focus14150","series-title":"J Bone Joint Surg Br","first-page":"779","article-title":"Osteomyelitis in a general hospital. A five-year study showing an increase in subacute osteomyelitis","volume":"69","author":"Jones","year":"1987"},{"issue":"300","key":"b16-focus14150","series-title":"Clin Orthop Relat Res","first-page":"45","article-title":"Anterior lumbar fusion options. Technique and graft materials","author":"Kozak","year":"1994"},{"key":"b17-focus14150","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1097\/BRS.0b013e31823551aa","article-title":"Direct lateral approach to lumbar fusion is a biomechanically equivalent alternative to the anterior approach: an in vitro study","volume":"37","author":"Laws","year":"2012"},{"key":"b18-focus14150","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"302","DOI":"10.3171\/2011.11.SPINE11653","article-title":"Complications of lateral plating in the minimally invasive lateral transpsoas approach. Clinical article","volume":"16","author":"Le","year":"2012"},{"key":"b19-focus14150","series-title":"Scientific-WorldJournal","first-page":"456346","article-title":"Stand-alone lateral interbody fusion for the treatment of low-grade degenerative spondylolisthesis","volume":"2012","author":"Marchi","year":"2012"},{"key":"b20-focus14150","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.spinee.2005.08.012","article-title":"Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion","volume":"6","author":"Ozgur","year":"2006"},{"key":"b21-focus14150","series-title":"J Bone Joint Surg Am","first-page":"667","article-title":"Anterior lumbar disc excision and interbody fusion used as salvage procedure","volume":"45","author":"Raney","year":"1963"},{"key":"b22-focus14150","series-title":"Youmans Neurological Surgery","first-page":"2831","article-title":"Infections of the spine","volume":"4","author":"Vollmer","year":"2012"},{"key":"b1-focus14150","series-title":"Nat Rev Nephrol","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1038\/nrneph.2011.105","article-title":"Spondylodiscitis in a patient on chronic hemodialysis","volume":"7","author":"Afshar","year":"2011"},{"key":"b2-focus14150","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2227","DOI":"10.1097\/00007632-199311000-00014","article-title":"Vascular injury in anterior lumbar surgery","volume":"18","author":"Baker","year":"1993"},{"key":"b3-focus14150","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E687","DOI":"10.1097\/BRS.0b013e3181ec5911","article-title":"Anatomic mapping of lumbar nerve roots during a direct lateral transpsoas approach to the spine: a cadaveric study","volume":"36","author":"Banagan","year":"2011"},{"key":"b4-focus14150","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"139","DOI":"10.3171\/2008.10.SPI08479","article-title":"An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine. Laboratory investigation","volume":"10","author":"Benglis","year":"2009"},{"issue":"Suppl 1","key":"b5-focus14150","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"S37","DOI":"10.1007\/s00586-012-2217-z","article-title":"Direct lateral access lumbar and thoracolumbar fusion: preliminary results","volume":"21","author":"Berjano","year":"2012"},{"key":"b6-focus14150","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1016\/j.spinee.2011.07.020","article-title":"Vertebral body fractures after transpsoas interbody fusion procedures","volume":"11","author":"Brier-Jones","year":"2011"},{"key":"b7-focus14150","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2695","DOI":"10.1097\/01.brs.0000244662.78725.37","article-title":"Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center","volume":"31","author":"Butler","year":"2006"},{"key":"b8-focus14150","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"227","DOI":"10.3171\/2012.5.SPINE1288","article-title":"Motor nerve injuries following the minimally invasive lateral transpsoas approach. Clinical article","volume":"17","author":"Cahill","year":"2012"},{"issue":"26 Suppl","key":"b9-focus14150","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S361","DOI":"10.1097\/BRS.0b013e318202308b","article-title":"Biomechanical analysis and review of lateral lumbar fusion constructs","volume":"35","author":"Cappuccino","year":"2010"},{"key":"b10-focus14150","series-title":"Int Orthop","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1007\/s002640050145","article-title":"Retrograde ejaculation after retroperitoneal lower lumbar interbody fusion","volume":"21","author":"Christensen","year":"1997"},{"key":"b11-focus14150","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2751","DOI":"10.1097\/BRS.0b013e31815a996e","article-title":"Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management","volume":"32","author":"Fantini","year":"2007"},{"key":"b12-focus14150","series-title":"Am J Surg","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.amjsurg.2006.08.085","article-title":"Open anterior approaches for lumbar spine procedures","volume":"194","author":"Gumbs","year":"2007"},{"key":"b13-focus14150","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/j.spinee.2006.05.015","article-title":"Revision open anterior approaches for spine procedures","volume":"7","author":"Gumbs","year":"2007"},{"issue":"3 Suppl","key":"b14-focus14150","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1227\/01.NEU.0000324520.95150.4C","article-title":"The history of spinal deformity","volume":"63","author":"Heary","year":"2008"},{"key":"b15-focus14150","series-title":"J Bone Joint Surg Br","first-page":"779","article-title":"Osteomyelitis in a general hospital. A five-year study showing an increase in subacute osteomyelitis","volume":"69","author":"Jones","year":"1987"},{"issue":"300","key":"b16-focus14150","series-title":"Clin Orthop Relat Res","first-page":"45","article-title":"Anterior lumbar fusion options. Technique and graft materials","author":"Kozak","year":"1994"},{"key":"b17-focus14150","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1097\/BRS.0b013e31823551aa","article-title":"Direct lateral approach to lumbar fusion is a biomechanically equivalent alternative to the anterior approach: an in vitro study","volume":"37","author":"Laws","year":"2012"},{"key":"b18-focus14150","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"302","DOI":"10.3171\/2011.11.SPINE11653","article-title":"Complications of lateral plating in the minimally invasive lateral transpsoas approach. Clinical article","volume":"16","author":"Le","year":"2012"},{"key":"b19-focus14150","series-title":"Scientific-WorldJournal","first-page":"456346","article-title":"Stand-alone lateral interbody fusion for the treatment of low-grade degenerative spondylolisthesis","volume":"2012","author":"Marchi","year":"2012"},{"key":"b20-focus14150","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.spinee.2005.08.012","article-title":"Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion","volume":"6","author":"Ozgur","year":"2006"},{"key":"b21-focus14150","series-title":"J Bone Joint Surg Am","first-page":"667","article-title":"Anterior lumbar disc excision and interbody fusion used as salvage procedure","volume":"45","author":"Raney","year":"1963"},{"key":"b22-focus14150","series-title":"Youmans Neurological Surgery","first-page":"2831","article-title":"Infections of the spine","volume":"4","author":"Vollmer","year":"2012"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/37\/2\/article-pE5.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/37\/2\/article-pE5.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/37\/2\/article-pE5.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T08:42:51Z","timestamp":1780130571000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/37\/2\/article-pE5.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,8]]},"references-count":44,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2014.6.focus14150","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,8]]}}}