A, Anterior approach for resection of L4-L5 disc, vertebral body of L5, and L5-S1 disc is made through incision extending transversely across both rectus abdominis muscles. Great vessels are mobilized laterally after being carefully identified, and structures to be resected are seen between bifurcation of vena cava and aorta. B, Preoperative and postoperative lateral radiograph. C, Radiographs of same patient 7 years later. Solid intertransverse fusion and interbody fusion are shown. Reconstructed L4-S1 intervertebral foramen is wide open on lateral radiograph. SEE TECHNIQUE 44.59.