scholarly journals The Minimally Invasive Retroperitoneal Transpsoas Approach

Spine Surgery ◽  
10.5772/38321 ◽  
2012 ◽  
Author(s):  
Tien V. ◽  
Juan S.
Keyword(s):  
Minimally Invasive ◽  
Transpsoas Approach

Minimally Invasive Lateral Retroperitoneal Approach for Resection of Extraforaminal Lumbar Plexus Schwannomas: Operative Techniques and Literature Review

2018 ◽  
Vol 15 (5) ◽  
pp. 516-521 ◽  
Author(s):  
Michael M Safaee ◽  
Christopher P Ames ◽  
Vedat Deviren ◽  
Aaron J Clark
Keyword(s):  
Minimally Invasive ◽  
Good Condition ◽  
Tumor Resection ◽  
Psoas Muscle ◽  
Lateral Approach ◽  
Lumbar Plexus ◽  
Retroperitoneal Approach ◽  
Transpsoas Approach ◽  
Lateral Interbody ◽  
Traditional Approaches

Abstract BACKGROUND Traditional approaches for retroperitoneal lumbar plexus schwannomas involve anterior open or laparoscopic resection. For select tumors, the lateral retroperitoneal approach provides a minimally invasive alternative. OBJECTIVE To describe a minimally invasive lateral transpsoas approach for the resection of retroperitoneal schwannomas. METHODS A lateral retroperitoneal transpsoas approach was used to resect a 3.1 × 2.7 × 4.1 cm schwannoma embedded within the psoas muscle. A minimally invasive retractor system allows for appropriate visualization and complete resection with the aid of the microscope. The patient tolerated the procedure without complication and was discharged on postoperative day 2 in good condition at her neurological baseline. RESULTS The lateral retroperitoneal approach provides a minimally invasive alternative for select retroperitoneal schwannomas. In theory, this procedure allows for faster recovery and less blood loss compared to traditional open anterior approaches. For a subset of tumors, anterior laparoscopy may provide better access, but the lateral approach is well known to most neurosurgeons who perform lateral interbody fusions and can be easily tailored to extraforaminal tumor resection. CONCLUSION Retroperitoneal schwannomas pose a challenge due to their deep location. The lateral retroperitoneal approach provides a useful alternative for resection of a subset of retroperitoneal schwannomas.

Safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: a morphometric study

2011 ◽  
Vol 33 (8) ◽  
pp. 665-671 ◽  
Author(s):  
Patrick Guérin ◽  
Ibrahim Obeid ◽  
Olivier Gille ◽  
Anouar Bourghli ◽  
Stéphane Luc ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Morphometric Study ◽  
Transpsoas Approach ◽  
Safe Working

Minimally Invasive Lateral Transpsoas Approach to the Lumbar Spine

2014 ◽  
Vol 25 (2) ◽  
pp. 219-231 ◽  
Author(s):  
Randall B. Graham ◽  
Albert P. Wong ◽  
John C. Liu
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Transpsoas Approach

Anterior Longitudinal Ligament Release From the Minimally Invasive Lateral Retroperitoneal Transpsoas Approach: Technical Note

2016 ◽  
Vol 12 (3) ◽  
pp. 214-221 ◽  
Author(s):  
Joshua M Beckman ◽  
Nicola Marengo ◽  
Gisela Murray ◽  
Konrad Bach ◽  
Juan S Uribe
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Vascular Complications ◽  
Deformity Correction ◽  
Anterior Longitudinal Ligament ◽  
Global Improvement ◽  
Transpsoas Approach ◽  
Indirect Decompression

Abstract BACKGROUND The technique for minimally invasive anterior longitudinal ligament release is a major advancement in lateral access surgery. This method provides hypermobility of lumbar segments to allow for aggressive lordosis restoration while maintaining the benefits of indirect decompression and minimally invasive access. OBJECTIVE To provide video demonstration of the lateral retroperitoneal transpsoas approach with anterior longitudinal ligament sectioning. METHODS A detailed surgical technique of the minimally invasive anterior column release is described and illustrated in an elderly patient with adult spinal deformity and low back pain (visual analog scale, 8 of 10) refractory to conservative measures. The 3-foot standing radiographs demonstrated a lumbar lordosis of 54.4°, pelvic incidence of 63.7°, and pelvic tilt of 17.5°. Computed tomography and magnetic resonance imaging showed generalized lumbar spondylosis and degenerative disc changes from L2 to L5. RESULTS The patient underwent a multilevel minimally invasive deformity correction with an anterior longitudinal ligament release at the L3/L4 level through the lateral retroperitoneal transpsoas approach. Lumbar lordosis increased from 54.4° to 77° with a global improvement in sagittal vertical axis from 4.37 cm to 0 cm. Total blood loss was less than 25 mL, and there were no major neurological or vascular complications. CONCLUSION The anterior longitudinal ligament release using the minimally invasive lateral approach allows for deformity correction without the morbidity and blood loss encountered by traditional open posterior approaches. However, the risk of major vascular/visceral complication warrants only experts in minimally invasive lateral surgery to attempt this technique.

scholarly journals Minimally Invasive Direct Lateral Transpsoas Approach for the Resection of a Lumbar Plexus Schwannoma: Technique Report

2016 ◽  
Vol 02 (03) ◽  
pp. e66-e69 ◽  
Author(s):  
Carolina Benjamin ◽  
Eric Oermann ◽  
J. Thomas ◽  
Casey Distaso ◽  
Faheem Sandhu
Keyword(s):  
Postoperative Complications ◽  
Minimally Invasive ◽  
Retroperitoneal Tumor ◽  
Lumbar Plexus ◽  
Intraoperative Blood Loss ◽  
Effective Technique ◽  
Tubular Retractor ◽  
Leg Strength ◽  
Transpsoas Approach ◽  
Retroperitoneal Schwannoma

Objective Traditional techniques for resection of lumbar plexus tumors have been associated with approach-related morbidity. We describe a case utilizing a minimally invasive transpsoas lateral access approach to resect a retroperitoneal tumor of the lumbar plexus. Methods We report a case with an extradural retroperitoneal schwannoma of the L4 nerve root that was treated with a minimally invasive direct lateral transpsoas approach using atraumatic tissue dilators and an expandable tubular retractor. The use of directional and continuous electromyographic monitoring was critical in locating the plexus and positioning the retractor immediately anterior to the tumor. Results The patient tolerated the procedure well without postoperative complications. The operative approach was direct and intraoperative blood loss was negligible. The patient demonstrated improved left leg strength and ambulation and resolution of paresthesias. Conclusions A minimally invasive direct lateral transpsoas access approach is an effective technique to safely and adequately resect extradural retroperitoneal lumbar plexus tumors.

Anterior longitudinal ligament release using the minimally invasive lateral retroperitoneal transpsoas approach: a cadaveric feasibility study and report of 4 clinical cases

2012 ◽  
Vol 17 (6) ◽  
pp. 530-539 ◽  
Author(s):  
Armen R. Deukmedjian ◽  
Tien V. Le ◽  
Ali A. Baaj ◽  
Elias Dakwar ◽  
Donald A. Smith ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lumbar Lordosis ◽  
Lumbar Disc ◽  
Vena Cava ◽  
Surgical Anatomy ◽  
Sagittal Imbalance ◽  
Anterior Longitudinal Ligament ◽  
Vertebral Column Resection ◽  
Transpsoas Approach ◽  
Clinical Cases

Object Traditional procedures for correction of sagittal imbalance via shortening of the posterior column include the Smith-Petersen osteotomy, pedicle subtraction osteotomy, and vertebral column resection. These procedures require wide exposure of the spinal column posteriorly, and may be associated with significant morbidity. Anterior longitudinal ligament (ALL) release using the minimally invasive lateral retroperitoneal approach with a resultant net lengthening of the anterior column has been performed as an alternative to increase lordosis. The objective of this study was to demonstrate the feasibility and early clinical experience of ALL release through a minimally invasive lateral retroperitoneal transpsoas approach, as well as to describe its surgical anatomy in the lumbar spine. Methods Forty-eight lumbar levels were dissected in 12 fresh-frozen cadaveric specimens to study the anatomy of the ALL as well as its surrounding structures, and to determine the feasibility of the technique. The lumbar disc spaces and ALL were accessed via the lateral transpsoas approach and confirmed with fluoroscopy in each specimen. As an adjunct, 4 clinical cases of ALL release through the minimally invasive lateral retroperitoneal transpsoas approach were reviewed. Operative technique, results, complications, and early outcomes were assessed. Results In the cadaveric study, sectioning of the ALL proved to be feasible from the minimally invasive lateral retroperitoneal transpsoas approach. The structures at most immediate risk during this procedure were the aorta, inferior vena cava, iliac vessels, and sympathetic plexus. The mean increase in segmental lumbar lordosis per level of ALL release was 10.2°, while global lumbar lordosis improved by 25°. Each level of ALL release took 56 minutes and produced 40 ml of blood loss on average. Visual analog scale and Oswestry Disability Index scores improved by 9 and 35 points, respectively. There were no cases of hardware failure, and as of yet no complications to report. Conclusions This initial experience suggests that ALL release through the minimally invasive lateral retroperitoneal transpsoas approach may be feasible, allows for improvement of lumbar lordosis without the need of an open laparotomy/thoracotomy, and minimizes the tissue disruption and morbidity associated with posterior osteotomies.

scholarly journals Contralateral psoas hematoma after minimally invasive, lateral retroperitoneal transpsoas lumbar interbody fusion: a multicenter review of 3950 lumbar levels

2017 ◽  
Vol 26 (1) ◽  
pp. 50-54 ◽  
Author(s):  
Joshua M. Beckman ◽  
Berney Vincent ◽  
Michael S. Park ◽  
James B. Billys ◽  
Robert E. Isaacs ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Rare Complication ◽  
Neurological Deficits ◽  
Preoperative Imaging ◽  
Lumbar Interbody Fusion ◽  
Segmental Artery ◽  
Delay In Diagnosis ◽  
Transpsoas Approach ◽  
Vessel Injury

OBJECTIVE Minimally invasive lateral lumbar interbody fusion (LLIF) via the retroperitoneal transpsoas approach is a technically demanding procedure with a multitude of potential complications. A relatively unknown complication is the contralateral psoas hematoma. The authors speculate that injury occurs from segmental vessel injury at the time of contralateral annulus release; however, this is not fully understood. In this multicenter retrospective review, the authors report the incidence of this contralateral complication and its neurological sequelae. METHODS This study was a retrospective chart review of all minimally invasive LLIF performed at participating institutions from 2008 to 2014. Exclusion criteria included an underlying diagnosis of trauma or neoplasia as well as lateral corpectomies or anterior column releases. Single-level, multilevel, and stand-alone constructs were included. All patients underwent preoperative MRI. Follow-up was at least 12 months. All complications and clinical outcomes were self-reported by each surgeon. RESULTS There were 3950 lumbar interbody cages placed via the retroperitoneal transpsoas approach, with 7 cases (0.18% incidence) of symptomatic contralateral psoas hematoma, 3 of which required reoperation for hematoma evacuation. Neurological outcome did not improve after reoperation. Reoperation occurred an average of 1 month after the initial operation due to a delay in diagnosis. In 1 case, segmental artery injury was confirmed at the time of surgery; in the others, segmental vessel injury was suspected, although it could not be confirmed. Neurological deficits persisted in 3 patients while the others remained neurologically intact. Two patients were receiving antiplatelet therapy prior to the procedure. CONCLUSIONS The contralateral psoas hematoma is a rare complication suspected to occur from segmental vessel injury during contralateral annulus release. Detailed review of preoperative imaging for aberrant vessel anatomy may prevent injury and subsequent neurological deficit.

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