The retroperitoneal approach to the lumbar spine is commonly used for anterior lumbar corpectomies, fusions, and total disc replacements. The approach is usually performed from the left as the aorta is more resistant to damage than the inferior vena cava (IVC). The bifurcation occurs over the vertebral body of L4. Therefore, L4/5 discectomies are performed by working on the left side of the aorta, while L5/S1 discectomies are performed by working between the bifurcation of the common iliac vessels. Anatomic features which are important to identify include the genitofemoral nerve, ureter, lumbar sympathetic chain, and lumbar segmental vessels.
