Changes in the Operative Corridor in Oblique Lumbar Interbody Fusion Between Preoperative Magnetic Resonance Imaging and Intraoperative Cone-Beam Computed Tomography Using Morphometric Analysis

Zehri, Aqib; Soriano-Baron, Hector; Peterson, Keyan; Kittel, Carol; Brown, Patrick; Hsu, Wesley; Neal, Matthew T.; Wilson, Jonathan L.

doi:10.7759/cureus.8687

Cited by 5 publications

(8 citation statements)

References 18 publications

(32 reference statements)

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“…Several prior studies have also assessed the safe interval between the iliac vessels or aorta and the anteromedial border of the psoas muscle during oblique lateral interbody fusion (OLIF) and these studies have shown significant changes in the safe interval, dependent both on patient positioning (supine vs lateral decubitus) and hip flexion vs extension. [26][27][28] Taking into consideration the results noted in the previously mentioned studies, 18,[25][26][27][28] it is likely that the more posterior location of the femoral nerve in the prone position compared to the lateral decubitus position, as seen in our study, is primarily the result of hip extension in the prone position and hip flexion in the lateral decubitus position. Based on the results of this study, the safe working corridor at the L4-L5 level may be larger when performing prone, as opposed to laterally positioned, LLIF.…”

Section: Discussionsupporting

confidence: 57%

Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

Alluri

Clark

Sheha

et al. 2021

Global Spine Journal

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Study Design Cadaveric study. Objective To compare the position of the femoral nerve within the lumbar plexus at the L4-L5 disc space in the lateral decubitus vs prone position. Methods Seven lumbar plexus specimens were dissected and the femoral nerve within the psoas muscle was identified and marked with radiopaque paint. Lateral fluoroscopic images of the cadaveric specimens in the lateral decubitus vs prone position were obtained. The location of the radiopaque femoral nerve at the L4-L5 disc space was normalized as a percentage of the L5 vertebral body (0% indicates posterior location and 100% indicates anterior location at the L4-L5 disc space). The location of the femoral nerve at L4-L5 in the lateral decubitus vs prone position was compared using a paired t test. Results In the lateral decubitus position, the femoral nerve was located 28% anteriorly from the posterior edge of the L4-L5 disc space, and in the prone position, the femoral nerve was relatively more posterior, located 18% from the posterior edge of the L4-L5 disc space ( P = .037). Conclusions The femoral nerve was on average more posteriorly located at the L4-L5 disc space in the prone position compared to lateral decubitus. This more posterior location allows for a larger safe zone at the L4-L5 disc space, which may decrease the incidence of neurologic complications associated with Lateral lumbar interbody fusion in the prone vs lateral decubitus position; however, further studies are needed to evaluate this possible clinical correlation.

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Section: Discussionsupporting

confidence: 57%

Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

Alluri

Clark

Sheha

et al. 2021

Global Spine Journal

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“…The authors demonstrated that the oblique corridor tends to be greater on the left side and that it gradually decreases in size the more caudal the level. 11,18 Results similar to those found in the present study, where we identified a significant difference between the size of the corridor in L3L4 and L4L5 in both positions.…”

Section: The Oblique Lateral Interbody Fusion Technique (Olif)supporting

confidence: 90%

Study of the Diameter of the Oblique Corridor in Lateral Decubitus and Dorsal Decubitus: Radiological Study

et al. 2022

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Introduction: Degenerative intervertebral disc disease and its impact on quality of life when associated with sagittal misalignmentis a current topic in the literature. The technique known as OLIF derives from the need to use anterior cage stop romote stabilization of the affected segment, indirect decompression, restoration of segmental lordosis, and sagittal balance. Methods: Single-center, non-randomized, comparative, observational study. The following variables were measured using magnetic resonance imaging of the lumbar spine in dorsal and lateral decubitus, establishing a comparison between the size of the OLIF corridor in the L3L4 and L4L5 segments, as well as a comparison of corridor size between the different positions. Results: There was no difference incorridor size in the comparison between decubitus. However, when the L3L4 and L4L5 levels were compared, there was a significant difference in the size of the corridor in both the lateral and dorsal positions. Conclusion: The present study did not show any difference between the size of the OLIF corridor in L3L4 and L4L5 in the different decubitus, suggesting that thee valuation of the corridor in convention al magnetic resonance images appearstobe safe andreflects the actual size when positio ned for performing the OLIF technique. Level of evidence III; Retrospective study.

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“…Radiographic (MRI) and cadaveric studies on the surgical windows developed following transpsoas LLIF and OLIF by disk level(s) are summarized in Table 3 9,10,14,18–20 Figure 8. highlights the progressive narrowing of the safe corridors between the nerve plexus and the prevertebral vessels at the lower lumbar levels, as mapped by Moro et al 16.…”

Section: Discussionmentioning

confidence: 99%

“…Dissimilar to our left-sided premobilization measurements, the authors found that the right decubitus position increased the left prepsoas surgical window sizes at all levels between L1 and L5, with the greatest relative increase noted at L1-L2 (average 3.1 mm) and the least at L4-L5 (average 2.1 mm) perhaps owing to the increasing volume of the psoas muscle more caudally. 10 Unlike the direct manual measurement method we adopted to determine the surgical corridor sizes, in the aforementioned study measurements' overestimation is plausible due to exclusive radiographic determination and the use of dissimilar imaging modalities (preoperative MRI and intraoperative computed tomography scan).…”

Section: Radiographic and Premobilization Measurementsmentioning

confidence: 99%

“…[6][7][8] Other studies are limited due to either small sample size, being exclusively radiographic, restricted to the left-sided approach, or simply omitted investigating the L5-S1 disk level. 9,10 This study is the first to report on the intraoperative surgical windows offered by the minimally invasive antepsoas (MIS-ATP) approach in both left and right lateral positions between L1 and S1. The primary aim of this study is to investigate the surgical corridor, defined as the space developed between the iliopsoas muscle (P) and the prevertebral major vessels (V).…”

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confidence: 99%

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The Antepsoas (ATP) Surgical Corridor for Lumbar and Lumbosacral Arthrodesis: A Radiographic, Anatomic, and Surgical Investigation

Tannoury

Das

Saade

et al. 2022

Spine

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Study Design. Retrospective review of prospectively collected data. Objective. To investigate the size of prepsoas surgical corridors, developed between the iliopsoas and prespinal vessels, at all disk levels between L1 and S1 granted by left and right lateral antepsoas (ATP) approaches. Secondary aims include evaluation of presurgery radiographic prepsoas windows between L1 and S1 with respect to the intraoperative findings. Summary of Background Data. The ATP technique is an evolving alternative to the transpsoas and direct anterior exposures for lumbar fusion. However, the vascular morphometric data of the ATP approach remain underexplored, especially at L5-S1. Materials and Methods. Patients indicated for ATP lumbar-lumbosacral fusion between September 2018 and February 2020 were enrolled (n = 121). Data were collected prospectively, including the following (in mm). intraoperative manual measurements of the premobilization psoas-vessel (pre-PV) window, the final postmobilization psoas-vessel (post-PV) window, and the preoperative radiographic psoas-to-vessel distance at the respective studied disk levels. Results. A total of 121 patients (75 female, mean age. 55.3 yr, 81.8% right-sided approach) underwent a total of 279 levels of spinal fusion. Irrespective of the ATP access laterality, we noted ample postmobilization psoas-vessel (post-PV differential) corridors: largest at L4-L5 (36-38 mm) followed by L5-S1 (31-35 mm), L3-L4 (32-33 mm), L2-L3 (28-30 mm), and L1-L2 (20-24 mm). Similarly, the relative increases of the psoas-vessel corridors (post-PV and pre-PV differentials, averaged: 31 mm at L5-S1, 32 mm at L4-L5, 26 mm at L3-L4, 25 mm at L2-L3, and 14 mm at L1-L2) were also significant in both lateral approaches. In right flank approaches, the right vascular structures projected more dorsally compared with left-sided vasculature (P < 0.05). Conclusion.The ATP access offers generous bilateral prepsoas surgical windows to L1-S1 intervertebral disks, allowing for a safe anterior column release, decompression, instrumentation, and fusion.

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Changes in the Operative Corridor in Oblique Lumbar Interbody Fusion Between Preoperative Magnetic Resonance Imaging and Intraoperative Cone-Beam Computed Tomography Using Morphometric Analysis

Cited by 5 publications

References 18 publications

Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

Study of the Diameter of the Oblique Corridor in Lateral Decubitus and Dorsal Decubitus: Radiological Study

The Antepsoas (ATP) Surgical Corridor for Lumbar and Lumbosacral Arthrodesis: A Radiographic, Anatomic, and Surgical Investigation

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