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

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.

scholarly journals MINIMALLY INVASIVE EXTREME LATERAL APPROACH IN SPINAL LUMBAR METASTASIS

2018 ◽  
Vol 26 (3) ◽  
pp. 191-193
Author(s):  
LUCAS CASTRILLON CARMO MACHADO ◽  
DOUGLAS KENJI NARAZAKI ◽  
WILLIAN GEMIO JACOBSEN TEIXEIRA ◽  
ALEXANDRE FOGAÇA CRISTANTE ◽  
MANOEL JACOBSEN TEIXEIRA ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Anterior Approach ◽  
Treatment Options ◽  
Spinal Metastases ◽  
Case Series ◽  
Psoas Muscle ◽  
Lateral Approach ◽  
Level Of Evidence ◽  
Transpsoas Approach

ABSTRACT Introduction The extreme lateral approach has been widely used for the treatment of degenerative diseases. The objective of this study is to present a minimally invasive extreme lateral approach for the treatment of metastatic lesions in the lumbar spine without the use of the evoked potential exam (MEP). Methods Two patients with spinal metastases and indication for surgery via the anterior approach were treated in a cancer referral center in Brazil. They were placed in right lateral decubitus, and an oblique incision was made, exposing the psoas muscle. The anterior approach permitted the release of the psoas muscle from vertebral body and disc, without the need for MEP. Conclusions When cancer cure is no longer possible, a minimally invasive extreme lateral approach to treat tumor metastases in the lumbar spine is a viable option, with short hospitalization time and low morbidity. The dislocation of the psoas muscle avoids the use of the transpsoas approach, which requires MEP equipment and a trained physician. Clinical studies are needed to extend these benefits to oncological patients who have treatment options for their primary disease. Level of Evidence IV; Case series.

Minimally invasive lateral lumbar interbody fusion and transpsoas approach–related morbidity

2011 ◽  
Vol 31 (4) ◽  
pp. E4 ◽  
Author(s):  
David J. Moller ◽  
Nicholas P. Slimack ◽  
Frank L. Acosta ◽  
Tyler R. Koski ◽  
Richard G. Fessler ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Motor Deficit ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion ◽  
Transpsoas Approach ◽  
Anterior Thigh ◽  
Hip Flexor

Object Recently, the minimally invasive, lateral retroperitoneal, transpsoas approach to the thoracolumbar spinal column has been described by various authors. This is known as the minimally invasive lateral lumbar interbody fusion. The purpose of this study is to elucidate the approach-related morbidity associated with the minimally invasive transpsoas approach to the lumbar spine. To date, there have been only a couple of reports regarding the morbidity of the transpsoas muscle approach. Methods A nonrandomized, prospective study utilizing a self-reported patient questionnaire was conducted between January 2006 and June 2008 at Northwestern University. Data were collected in 53 patients with a follow-up period ranging from 6 months to 3.5 years. Only 2 patients were lost to follow-up. Results Thirty-six percent (19 of 53) of patients reported subjective hip flexor weakness, 25% (13 of 53) anterior thigh numbness, and 23% (12 of 53) anterior thigh pain. However, 84% of the 19 patients reported complete resolution of their subjective hip flexor weakness by 6 months, and most experienced improved strength by 8 weeks. Of those reporting anterior thigh numbness and pain, 69% and 75% improved to their baseline function by the 6-month follow-up evaluations, respectively. All patients with self-reported subjective hip flexor weakness underwent examinations during subsequent clinic visits after surgery; however, these examinations did not confirm a motor deficit less than Grade 5. Subset analysis showed that the L3–4 and L4–5 levels were most often affected. Conclusions The minimally invasive, transpsoas muscle approach to the lumbar spine has a number of advantages. The data show that a percentage of the patients undergoing the transpsoas approach will have temporary sensory and motor symptoms related to this approach. The majority of the symptoms are thought to be related to psoas muscle inflammation and/or stretch injury to the genitofemoral nerve due to the surgical corridor traversed during the operation. No major injuries to the lumbar plexus were encountered. It is important to educate patients prior to surgery of the possibility of these largely transient symptoms.

scholarly journals Radiographic Accuracy of Percutaneous Pedicle Screw Placement in Fluoroscopic- Versus CT Navigation-Guided Lumbar Spine Instrumentation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Guang-Ting Cong ◽  
Avani Vaishnav ◽  
Joseph Barbera ◽  
Hiroshi Kumagai ◽  
James Dowdell ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Intraoperative Computed Tomography ◽  
Percutaneous Pedicle Screw ◽  
Spine Instrumentation ◽  
Surgical Methods

Abstract INTRODUCTION Posterior spinal instrumentation for fusion using intraoperative computed tomography (CT) navigation is gaining traction as an alternative to the conventional two-dimensional fluoroscopic-guided approach to percutaneous pedicle screw placement. However, few studies to date have directly compared outcomes of these 2 minimally invasive instrumentation methods. METHODS A consecutive cohort of patients undergoing primary percutaneous posterior lumbar spine instrumentation for spine fusion was retrospectively reviewed. Revision surgeries or cases converted to open were excluded. Accuracy of screw placement was assessed using a postoperative CT scan with blinding to the surgical methods used. The Gertzbein-Robbins classification was used to grade cortical breach: Grade 0 (<0 mm cortical breach), Grade I (<2 mm), Grade II (2-4 mm), Grade III (4-6 mm), and Grade IV (>6 mm). RESULTS CT navigation was found to significantly improve accuracy of screw placement (P < .022). There was significantly more facet violation of the unfused level in the fluoroscopy group vs the CT group (9% vs 0.5%; P < .0001). There was also a higher proportion of poor screw placement in the fluoroscopy group (10.1% vs 3.6%). No statistical difference was found in the rate of tip breach, inferomedial breach, or lateral breach. Regression analysis showed that fluoroscopy had twice the odds of incurring poor screw placement as compared to CT navigation. CONCLUSION This radiographic study comparing screw placement in minimally invasive fluoroscopy- vs CT navigation-guided lumbar spine instrumentation provides evidence that CT navigation significantly improves accuracy of screw placement, especially in optimizing the screw trajectory so as to avoid facet violation. Long-term follow-up studies should be performed to ascertain whether this difference can contribute to an improvement in clinical outcomes.

scholarly journals Minimal Invasive Percutaneous Fixation of Thoracic and Lumbar Spine Fractures

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Federico De Iure ◽  
Michele Cappuccio ◽  
Stefania Paderni ◽  
Giuseppe Bosco ◽  
Luca Amendola
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Minimal Invasive ◽  
Minimally Invasive Technique ◽  
Radiographic Evaluation ◽  
Invasive Technique ◽  
Spine Fractures ◽  
Percutaneous Fixation ◽  
Transpedicular Fixation ◽  
Thoracic And Lumbar Spine

We studied 122 patients with 163 fractures of the thoracic and lumbar spine undergoing the surgical treatment by percutaneous transpedicular fixation and stabilization with minimally invasive technique. Patient followup ranged from 6 to 72 months (mean 38 months), and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous transpedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures.

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