Anterior To Psoas lumbar and lumbosacral combined with posterior reconstruction in Adult Spinal Deformity: A bicentric European study

•ATP approaches are effective lesser invasive techniques for ASD correction, with a negligible risk to retroperitoneal vascular and neural structures. . They allow direct handing of the anterior longitudinal ligament and can span the entire lumbosacral column bar L1-2 in one single positioning.•In addition, this paper investigates the results of direct lumbotomy approaches compared to oblique lateral ones finding that the former may be more suitable in fragile elderly patients with de novo deformities, due to the observed reduced rates of intraoperative blood loss and surgical times.•Both ATP approaches lead to rates of pseudoarthrosis at the lower end of the reported data for similar cases, operated with either posterior only or trans-psoas approaches.