Periumbilical anterior retroperitoneal approach for lumbar disc replacement: Technical description with an illustrative case

We describe the surgical technique of the periumbilical anterior retroperitoneal approach for lumbar disc replacement (LDR) and the initial clinical experience, emphasizing relevant anatomical landmarks, exposure techniques, and key technical considerations for anterior exposure during LDR. The operative workflow of the periumbilical anterior retroperitoneal approach was described, including pre-operative planning, design of the periumbilical incision, entry into the retroperitoneal space, mobilization of vascular structures, and exposure of lumbar disc levels. Essential steps of disc removal, trial placement, and prosthesis implantation under fluoroscopic guidance were outlined. Post-operative care and early clinical experience were also summarized, with a representative operative case demonstrating important anatomical landmarks and procedural stages. The approach provided adequate exposure for single- and multilevel LDR while preserving the integrity of the abdominal wall. In our initial case, no major vascular, urologic, or neurologic complications were encountered, and the patient showed satisfactory early post-operative recovery with an acceptable cosmetic result. The periumbilical anterior retroperitoneal approach appears to be a technically feasible alternative to traditional anterior lumbar exposure techniques for LDR. It facilitates multilevel access while minimizing soft-tissue disruption and preserving abdominal wall structures. Although early outcomes are encouraging, further studies with larger cohorts and long-term follow-up are needed to validate its safety and durability.