Approaches to the spine have experienced similar evolutionary changes. Prior to the 1950s, most anterior lumbar approaches were extensive transperitoneal exposures (i.e. through the membrane lining the walls of the abdominal and pelvic cavities). In 1957, Southwick and Robinson introduced the retroperitoneal approach (i.e., behind the peritoneum).

“As well as synthetic metallic devices have been applied as fixation implements to aid in lumbar interbody fusion”

Transperitoneal exposures (i.e., through the peritoneum) require an incision of both the anterior and posterior peritoneum. In contrast, retroperitoneal exposures maintain the integrity of the peritoneum and approach the spinal column laterally behind the bowel and peritoneal contents. This has the advantage of less post-operative bowel problems.