Lateral retroperitoneal approach for surgical treatment of lumbar diskitis/osteomyelitis with post-infectious spinal deformity

Lumbar diskitis/osteomyelitis (LDO) can cause destruction of the anterior and middle spinal column leading to loss of structural integrity further compounded by iatrogenic violation of the posterior tension band during initial decompressive surgeries. Progressive deformity and/or medically refractory infection may necessitate aggressive debridement and reconstructive arthrodesis. Anterior debridement and reconstruction with posterior stabilization is an effective treatment option; however, existing open surgical techniques have limited efficacy for correction of the focal deformity, which can expose the patient to long term sagittal imbalance, pain, and disability. The aim of this chapter is to briefly review the epidemiology, pathophysiology, clinical presentation, and the role of medical versus surgical management in LDO. The role of the lateral retroperitoneal approach to the lumbar spine is then discussed and illustrated with two clinical cases.