Minimally invasive surgical approaches (MIS) to the lumbar spine have rapidly evolved, and the technical feasibility and safety of minimally invasive interbody fusion is well established. Revision surgery is technically more challenging and may cause avoidance of such approaches because of altered anatomy and absent bony landmarks. Furthermore revision surgery is often associated with an increasing complication rate. Description of minimally invasive surgery approaches among revision patients and the feasibility of such techniques demands clarification 8. In some cases the result of a double approach, combined anterior (minimal invasive ALIF) and posterior (dynamic neutralization with MIS paraspinal approach) is less invasive in terms of duration, bleeding and recovery compared to a pure, single posterior traditional approach 11,16.
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