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The midline anterior retroperitoneal approach from the right side is a safe alternative compared with the classical approach from the left side. The low rate of venous injury is explained by the sidewall thickness of the vena cava compared with the left iliac vein sidewall. Contrary to what happens by left-sided approach, the vascular retraction required for access to L4-L5 and above does not lead to arterial occlusion and therefore diminishes the risk in atheromatous patients. The absence of retrograde ejaculation confirms previous studies conducted on the left anastomosis of the superior hypogastric plexus, suggesting that its approach and mobilization by the left side are delicate.

Two-level lumbar disc replacement improves spinal function while preserving its mobility. But this procedure is fraught with risks and must be carried out by a highly-experienced team. A longer follow-up is needed to evaluate the sustainability of the results and to detect any adjacent segment disease. The French National Authority for Health (HAS) has recommended against two-level lumbar disc replacement, so it no longer can be performed in France.

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