====Lumbar spine=====
This region presents unique challenges that magnify the difficulty of the posterior only approach. Because of the more robust paraspinal musculature and anterior location of the lumbar spine, the length of incision and paraspinal dissection in the lumbar spine need to be very extensive in order to achieve the appropriate oblique trajectory for placement of a central cage. Further, nerve roots cannot be sacrificed and must be circumnavigated during the placement of anterior instrumentation from the posterior only approach.

Despite the difficulties associated with a posterior only approach, there remains a significant appeal, especially so in the oncologic setting. The posterior approach is the most familiar, and most patients who really need surgery require a posterior approach to decompress the spinal canal regardless of whether an anterior approach is performed.