scholarly journals Cadaveric Evidence of Complete Transection of the Lumbar Sympathetic Trunk After Extreme Lateral Transpsoas Approach to the Lumbar Spine: A Word of Caution

Cureus ◽  
2021 ◽  
Author(s):  
Joe Iwanaga ◽  
Tyler Zeoli ◽  
Tyler Scullen ◽  
Christopher Maulucci ◽  
R. Shane Tubbs
Keyword(s):  
Lumbar Spine ◽  
Sympathetic Trunk ◽  
Transpsoas Approach ◽  
Complete Transection

Is the Lateral Transpsoas Approach to the Lumbar Spine Safe at L4–L5?

2018 ◽  
Vol 31 (2) ◽  
pp. 49-52 ◽  
Author(s):  
Scott C. Wagner ◽  
Alexander R. Vaccaro ◽  
Adam J. Bevevino
Keyword(s):  
Lumbar Spine ◽  
Transpsoas Approach

A MRI study of lumbar plexus with respect to the lateral transpsoas approach to the lumbar spine

2015 ◽  
Vol 24 (11) ◽  
pp. 2538-2545 ◽  
Author(s):  
Lei He ◽  
Zhuang Kang ◽  
Wen-Jie Tang ◽  
Li-Min Rong
Keyword(s):  
Lumbar Spine ◽  
Lumbar Plexus ◽  
Transpsoas Approach ◽  
Mri Study

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

Endoscopic Lateral Transpsoas Approach to the Lumbar Spine

Spine ◽  
2004 ◽  
Vol 29 (15) ◽  
pp. 1681-1688 ◽  
Author(s):  
Darren L. Bergey ◽  
Alan T. Villavicencio ◽  
Theodore Goldstein ◽  
John J. Regan
Keyword(s):  
Lumbar Spine ◽  
Transpsoas Approach

scholarly journals Retroperitoneal oblique corridor to the L2–S1 intervertebral discs: an MRI study

2016 ◽  
Vol 24 (2) ◽  
pp. 248-255 ◽  
Author(s):  
Diana M. Molinares ◽  
Timothy T. Davis ◽  
Daniel A. Fung
Keyword(s):  
Lumbar Spine ◽  
Intervertebral Disc ◽  
Vertebral Body ◽  
Psoas Muscle ◽  
Intervertebral Discs ◽  
Mr Images ◽  
Disc Space ◽  
Iliac Vessel ◽  
Medial Border ◽  
Transpsoas Approach

OBJECT The purpose of this study was to analyze MR images of the lumbar spine and document: 1) the oblique corridor at each lumbar disc level between the psoas muscle and the great vessels, and 2) oblique access to the L5–S1 disc space. Access to the lumbar spine without disruption of the psoas muscle could translate into decreased frequency of postoperative neurological complications observed after a transpsoas approach. The authors investigated the retroperitoneal oblique corridor of L2–S1 as a means of surgical access to the intervertebral discs. This oblique approach avoids the psoas muscle and is a safe and potentially superior alternative to the lateral transpsoas approach used by many surgeons. METHODS One hundred thirty-three MRI studies performed between May 4, 2012, and February 27, 2013, were randomly selected from the authors’ database. Thirty-three MR images were excluded due to technical issues or altered lumbar anatomy due to previous spine surgery. The oblique corridor was defined as the distance between the left lateral border of the aorta (or iliac artery) and the anterior medial border of the psoas. The L5–S1 oblique corridor was defined transversely from the midsagittal line of the inferior endplate of L-5 to the medial border of the left common iliac vessel (axial view) and vertically to the first vascular structure that crossed midline (sagittal view). RESULTS The oblique corridor measurements to the L2–5 discs have the following mean distances: L2–3 = 16.04 mm, L3–4 = 14.21 mm, and L4–5 = 10.28 mm. The L5–S1 corridor mean distance was 10 mm between midline and left common iliac vessel, and 10.13 mm from the first midline vessel to the inferior endplate of L-5. The bifurcation of the aorta and confluence of the vena cava were also analyzed in this study. The aortic bifurcation was found at the L-3 vertebral body in 2% of the MR images, at the L3–4 disc in 5%, at the L-4 vertebral body in 43%, at the L4–5 disc in 11%, and at the L-5 vertebral body in 9%. The confluence of the iliac veins was found at lower levels: 45% at the L-4 level, 19.39% at the L4–5 intervertebral disc, and 34% at the L-5 vertebral body. CONCLUSIONS An oblique corridor of access to the L2–5 discs was found in 90% of the MR images (99% access to L2–3, 100% access to L3–4, and 91% access to L4–5). Access to the L5–S1 disc was also established in 69% of the MR images analyzed. The lower the confluence of iliac veins, the less probable it was that access to the L5–S1 intervertebral disc space was observed. These findings support the use of lumbar MRI as a tool to predetermine the presence of an oblique corridor for access to the L2–S1 intervertebral disc spaces prior to lumbar spine surgery.

An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine

2009 ◽  
Vol 10 (2) ◽  
pp. 139-144 ◽  
Author(s):  
David M. Benglis ◽  
Steve Vanni ◽  
Allan D. Levi
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Psoas Muscle ◽  
Anatomical Study ◽  
Lumbosacral Plexus ◽  
Disc Space ◽  
Lateral Interbody Fusion ◽  
Transpsoas Approach ◽  
Lateral Interbody

Object Minimally invasive anterolateral approaches to the lumbar spine are options for the treatment of a number of adult degenerative spinal disorders. Nerve injuries during these surgeries, although rare, can be devastating complications. With an increasing number of spine surgeons utilizing minimal access retroperitoneal surgery to treat lumbar problems, the frequency of complications associated with this approach will likely increase. The authors sought to better understand the location of the lumbar contribution of the lumbosacral plexus relative to the disc spaces encountered when performing the minimally invasive transpsoas approach, also known as extreme lateral interbody fusion or direct lateral interbody fusion. Methods Three fresh cadavers were placed lateral, and a total of 3 dissections of the lumbar contribution of the lumbosacral plexus were performed. Radiopaque soldering wire was then laid along the anterior margin of the nerve fibers and the exiting femoral nerve. Markers were placed at the disc spaces and lateral fluoroscopy was used to measure the location of the lumbar plexus along each respective disc space in the lumbar spine (L1–2, L2–3, L3–4, and L4–5). Results The lumbosacral plexus was found lying within the substance of the psoas muscle between the junction of the transverse process and vertebral body and exited along the medial edge of the psoas distally. The lumbosacral plexus was most dorsally positioned at the posterior endplate of L1–2. A general trend of progressive ventral migration of the plexus on the disc space was noted at L2–3, L3–4, and L4–5. Average ratios were calculated at each level (location of the plexus from the dorsal endplate to total disc length) and were 0 (L1–2), 0.11 (L2–3), 0.18 (L3–4), and 0.28 (L4–5). Conclusions This anatomical study suggests that positioning the dilator and/or retractor in a posterior position of the disc space may result in nerve injury to the lumbosacral plexus, especially at the L4–5 level. The risk of injuring inherent nerve branches directed to the psoas muscle as well as injury to the genitofemoral nerve do still exist.

The Relationship of Intrapsoas Nerves During a Transpsoas Approach to the Lumbar Spine

2010 ◽  
Vol 23 (4) ◽  
pp. 223-228 ◽  
Author(s):  
Daniel K. Park ◽  
Michael J. Lee ◽  
Eric L. Lin ◽  
Kern Singh ◽  
Howard S. An ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Transpsoas Approach ◽  
Relationship Of ◽  
The Relationship
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