An MRI study of psoas major and abdominal large vessels with respect to the X/DLIF approach

Hu, Wan-Kun; He, Shisheng; Zhang, Shaocheng; Liu, Yanbin; Li, Ming; Hou, Tiesheng; Ma, Xiaolu; Wang, Jian

doi:10.1007/s00586-010-1609-1

Cited by 83 publications

(43 citation statements)

References 19 publications

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“…To reduce risk of vascular injury, lateral approaches have been established [28,29]. The ''extreme'' or ''direct lateral'' transpsoas approaches have increased in popularity, partly because of the natural distance to the abdominal vessels [19,30,38,40]. However, numerous studies have shown neurologic injury resulting from this transpsoas approach, which is in close anatomic proximity to the lumbar nerve plexus [2,16,18,25,26].…”

Section: Discussionmentioning

confidence: 99%

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Mehren

Mayer

Zandanell

et al. 2016

Clinical Orthopaedics &Amp; Related Research

133

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Background During the last 20 years several less-invasive anterior approaches to the lumbar spine have become standard, including the extreme lateral transpsoas approach. Although it is associated with a lower risk of vascular injury compared with anterior midline approaches, neuromonitoring is considered mandatory to avoid neurologic complications. Interestingly, despite neuromonitoring, the reported risk of neurologic deficits with the extreme lateral transpsoas approach is greater than observed with other anterior approaches. An alternative lateral, oblique, psoassparing approach, recently named the oblique lumbar interbody fusion, uses the anatomic pathway between the abdominal vessels anteriorly and the lumbar plexus laterally to decrease the risk of neurologic and vascular injury; however, as yet, little on this new approach has been reported. Questions/purposesWe asked: what proportion of patients experienced (1) perioperative complications (overall complications), (2) vascular complications, and (3) neurologic complications after less-invasive anterior lumbar interbody fusion through the oblique lumbar interbody approach at one high-volume center? Methods We performed a chart review of intra-and perioperative complications of all patients who had undergone minimally invasive anterior lumbar interbody fusion through a lateral psoas-sparing approach from L1 to L5 during a 12-year period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). During the study period, the oblique, psoas-sparing approach was the preferred approach of the participating surgeons in this study, and it was performed in 812 patients, all of whom are studied here, and all of whom have complete data for assessment of the short-term (inpatient-only) complications that we studied. In general, we performed this approach whenever possible, although it generally was avoided when a patient previously had undergone an open retro-or transperitoneal abdominal procedure, or previous implantation of hernia mesh in the abdomen. During the study period, posterior fusion techniques were used in an additional 573 patients instead of the oblique lumbar interbody fusion when we needed to decompress the spinal canal beyond what is possible through the anterior approach. In case of spinal stenosis calling for fusion in combination with a high disc space, severe endplate irregularity, or severe biomechanical instability, we combined posterior decompression with oblique lumbar interbody fusion in 367 patients. Complications were evaluated by an independent observer who was not involved in the decisionmaking process, the operative procedure, nor the Each author certifies that he or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 ed...

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Section: Discussionmentioning

confidence: 99%

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Mehren

Mayer

Zandanell

et al. 2016

Clinical Orthopaedics &Amp; Related Research

133

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“…Another study by Regev confirmed that the safe surgical corridor decreases from 47.9% at L1-L2 to 13.1% at L4-L5 of the anterior-posterior diameter of the vertebra [8]. Additionally, surgeons should consider the risk of vascular injuries due to surgical proximity to major vessels, especially in right-sided approaches [18]. However, these studies were anatomic cadaveric studies which may or may not be reflective of in vivo operating conditions.…”

Section: Discussionmentioning

confidence: 99%

Neurologic deficit following lateral lumbar interbody fusion

et al. 2011

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Purpose Lateral lumbar interbody fusion (LLIF) is a minimally invasive technique that has gained growing interest in recent years. We performed a retrospective review of the medical records and operative reports of patients undergoing LLIF between March 2006 and December 2009. We seek to identify the incidence and nature of neurological deficits following LLIF. Methods New occurring sensory and motor deficits were recorded at 6 and 12 weeks as well as 6-and 12 months of follow-up. Motor deficits were grouped according to the muscle weakness and severity and sensory deficits to the dermatomal zone. New events were correlated to the patient demographics, pre-operative diagnosis, operative levels, and duration of surgery. At each post-operative time-point patients were queried regarding the presence of leg pain. Results A total of 235 patients (139 F; 96 M) with a total of 444 levels fused were included. Average age was 61.5 and mean BMI 28.3. At 12 months' follow-up, the prevalence of sensory deficits was 1.6%, psoas mechanical deficit was 1.6% and lumbar plexus related deficits 2.9%. Although there was no significant correlation between the surgical level L4-5 and an increased psoas mechanical flexion or lumbar plexus related motor deficit, a trend was observed. Independent risk factors for both psoas mechanical hip flexion deficit and lumbar plexus related motor deficit was duration of surgery.

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“…14,21,33 The transpsoas approach does, however, pose risk to neural structures of the lumbar plexus as they course through the psoas. 2,12,13,15,21 The large muscle belly of the psoas and overlap of the iliac crest make access to the L4-5 disc difficult and eliminate access to the L5-S1 disc.…”

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confidence: 99%

Retroperitoneal oblique corridor to the L2–S1 intervertebral discs in the lateral position: an anatomic study

Davis

Hynes²,

Fung

et al. 2014

SPI

163

145

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Object Access to the intervertebral discs from L2–S1 in one surgical position can be challenging. The transpsoas minimally invasive surgical (MIS) approach is preferred by many surgeons, but this approach poses potential risk to neural structures of the lumbar plexus as they course through the psoas. The lumbar plexus and iliac crest often restrict the L4–5 disc access, and the L5–S1 level has not been a viable option from a direct lateral approach. The purpose of the present study was to investigate an MIS oblique corridor to the L2–S1 intervertebral disc space in cadaveric specimens while keeping the specimens in a lateral decubitus position with minimal disruption of the psoas and lumbar plexus. Methods Twenty fresh-frozen full-torso cadaveric specimens were dissected, and an oblique anatomical corridor to access the L2–S1 discs was examined. Measurements were taken in a static state and with mild retraction of the psoas. The access corridor was defined at L2–5 as the left lateral border of the aorta (or iliac artery) and the anterior medial border of the psoas. The L5–S1 corridor of access was defined transversely from the midsagittal line of the inferior endplate of L-5 to the medial border of the left common iliac vessel and vertically to the first vascular structure that crosses midline. Results The mean access corridor diameters in the static state and with mild psoas retraction, respectively, were as follows: at L2–3, 18.60 mm and 25.50 mm; at L3–4, 19.25 mm and 27.05 mm; and at L4–5, 15.00 mm and 24.45 mm. The L5–S1 corridor mean values were 14.75 mm transversely, from midline to the left common iliac vessel and 23.85 mm from the inferior endplate of L-5 cephalad to the first midline vessel. Conclusions The oblique corridor allows access to the L2–S1 discs while keeping the patient in a lateral decubitus position without a break in the table. Minimal psoas retraction without significant tendon disruption allowed for a generous corridor to the disc space. The L5–S1 disc space can be accessed from an oblique angle consistently with gentle retraction of the iliac vessels. This study supports the potential of an MIS oblique retroperitoneal approach to the L2–S1 discs.

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An MRI study of psoas major and abdominal large vessels with respect to the X/DLIF approach

Cited by 83 publications

References 19 publications

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Neurologic deficit following lateral lumbar interbody fusion

Retroperitoneal oblique corridor to the L2–S1 intervertebral discs in the lateral position: an anatomic study

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