A Crucial But Neglected Anatomical Factor Underneath Psoas Muscle and Its Clinical Value in Lateral Lumbar Interbody Fusion—The Cleft of Psoas Major ( CPM )

The prepsoas retroperitoneal approach is a minimally invasive technique used for anterior lumbar interbody fusion. The approach may have a more favorable risk profile than the transpsoas approach, decreasing the risks that come with dissecting through the psoas muscle. However, the oblique angle of the spine in the prepsoas approach can be disorienting and challenging. This technical report provides an overview of the use of navigation in prepsoas oblique lateral lumbar interbody fusion in a series of 49 patients.

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Symptomatic contralateral osteophyte fracture with migration causing lumbar plexopathy during oblique lumbar interbody fusion: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21210 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Brenton Pennicooke ◽

Jeremy Guinn ◽

Dean Chou

Keyword(s):

Interbody Fusion ◽

Psoas Muscle ◽

Surgical Excision ◽

Contralateral Side ◽

Illustrative Case ◽

Lumbar Interbody Fusion ◽

Fusion Surgery ◽

Lateral Lumbar Interbody Fusion ◽

Bony Fragment ◽

Oblique Lumbar Interbody Fusion

BACKGROUND While performing lateral lumbar interbody fusion surgery, one of the surgical goals is to release the contralateral side with a Cobb elevator, allowing distraction of the interbody space. Many times, there are large osteophytes on the contralateral side, and the osteophytes can be split open with the Cobb or blunt instrument. It is extremely rare for the actual osteophyte to break off from the vertebral body into the contralateral psoas muscle and lumbar plexus. OBSERVATIONS The authors report a case of symptomatic lumbar plexopathy caused by an osteophyte fracture after an oblique lumbar interbody fusion requiring a right-sided anterior approach to excise the bony fragment. They illustrate the case with imaging that the radiologist did not comment on, and they also show a video of the surgical excision of the osteophyte through a right-sided anterior lumbar retroperitoneal approach. The authors also show how the patient had spontaneous right-sided electromyography (EMG) firing before excision of the osteophyte and how the EMG firing resolved after excision. LESSONS Although the literature is plentiful with regard to ipsilateral approach–related complications, the authors discuss the literature with regard to contralateral complications after minimally invasive lateral lumbar interbody fusion.

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Radiographs assessment of changes in the psoas muscle at L4-L5 level after single-level lateral lumbar interbody fusion in patients with postoperative motor weakness

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2021.05.057 ◽

2021 ◽

Vol 90 ◽

pp. 165-170

Author(s):

Akihiko Hiyama ◽

Hiroyuki Katoh ◽

Satoshi Nomura ◽

Daisuke Sakai ◽

Masato Sato ◽

...

Keyword(s):

Interbody Fusion ◽

Psoas Muscle ◽

Lumbar Interbody Fusion ◽

Motor Weakness ◽

Single Level ◽

Lateral Lumbar Interbody Fusion

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Lateral lumbar interbody fusion (LLIF): Technique and outcomes

Grande Medical Journal ◽

10.3126/gmj.v1i1.22399 ◽

2019 ◽

Vol 1 (1) ◽

pp. 1-7

Author(s):

Chester E. Sutterlin ◽

Jane E. Luscombe ◽

Jerry Day ◽

Arvind Dubey

Keyword(s):

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Psoas Muscle ◽

Surface Characteristics ◽

Bone Graft Substitute ◽

Lumbar Interbody Fusion ◽

Titanium Cage ◽

Lateral Lumbar Interbody Fusion ◽

Minimally Invasive Surgical ◽

3D Printed

Introduction: Historically, an interbody device (IBD) has consisted of morselized autograft1, structural autograft, structural allograft, stainless steel ball, threaded titanium cage, polyetheretherketone (PEEK) cage, and more recently 3D printed titanium cage with bioactive surface characteristics and bony ingrowth into IBD interstices. These IBD’s have been inserted through a variety of approaches, both by open technique and by minimally invasive surgical (MIS) technique. Traditionally, the most common procedures have been posterior lumbar interbody fusion (PLIF), transfacetal lumbar interbody fusion (TLIF), and anterior lumbar interbody fusion (ALIF). Obviously, both PLIF and TLIF are posterior approaches, and ALIF is an anterior approach. More recent approaches in the retroperitoneal space anteriorly are oblique lumbar interbody fusion (OLIF) anterior to the psoas muscle, and lateral lumbar interbody fusion (LLIF) which is a transpsoas procedure. LLIF is the subject of this manuscript. The LLIF technique utilizing K2M’s Ravine retractor system and K2M’s lateral IBD’s, Aleutian (PEEK) and Cascadia (3D printed titanium) will be described (K2M, Leesburg, VA USA). Bone graft substitute, iFactor (Cerapedics, Colorado USA), was used in all cases. No autograft was harvested from the iliac crest, but local morselized autograft was utilized if available. The clinical outcomes for LLIF using these implants and instruments will be reported.

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Use of 3D CT-based navigation in minimally invasive lateral lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2016.2.spine151295 ◽

2016 ◽

Vol 25 (3) ◽

pp. 339-344 ◽

Cited By ~ 15

Author(s):

Jacob R. Joseph ◽

Brandon W. Smith ◽

Rakesh D. Patel ◽

Paul Park

Keyword(s):

Interbody Fusion ◽

Cone Beam Ct ◽

Psoas Muscle ◽

Lumbar Interbody Fusion ◽

Related Complication ◽

Disc Space ◽

Image Guided ◽

Lateral Lumbar Interbody Fusion ◽

Intraoperative Fluoroscopy ◽

Spinal Navigation

OBJECTIVE Lateral lumbar interbody fusion (LLIF) is an increasingly popular technique used to treat degenerative lumbar disease. The technique of using an intraoperative cone-beam CT (iCBCT) and an image-guided navigation system (IGNS) for LLIF cage placement has been previously described. However, other than a small feasibility study, there has been no clinical study evaluating its accuracy or safety. Therefore, the purpose of this study was to evaluate the accuracy and safety of image-guided spinal navigation in LLIF. METHODS An analysis of a prospectively acquired database was performed. Thirty-one consecutive patients were identified. Accuracy was initially determined by comparison of the planned trajectory of the IGNS with post–cage placement intraoperative fluoroscopy. Accuracy was subsequently confirmed by postprocedural CT and/or radiography. Cage placement was graded based on a previously described system separating the disc space into quarters. RESULTS The mean patient age was 63.9 years. A total of 66 spinal levels were treated, with a mean of 2.1 levels (range 1–4) treated per patient. Cage placement was noted to be accurate using IGNS in each case, as confirmed with intraoperative fluoroscopy and postoperative imaging. Sixty-four (97%) cages were placed within Quarters 1 to 2 or 2 to 3, indicating placement of the cage in the anterior or middle portions of the disc space. There were no instances of misguidance by IGNS. There was 1 significant approach-related complication (psoas muscle abscess) that required intervention, and 8 patients with transient, mild thigh paresthesias or weakness. CONCLUSIONS LLIF can be safely and accurately performed utilizing iCBCT and IGNS. Accuracy is acceptable for multilevel procedures.

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Psoas Morphology Differs between Supine and Sitting Magnetic Resonance Imaging Lumbar Spine: Implications for Lateral Lumbar Interbody Fusion

Asian Spine Journal ◽

10.4184/asj.2018.12.1.29 ◽

2018 ◽

Vol 12 (1) ◽

pp. 29-36 ◽

Cited By ~ 4

Author(s):

Aaron J. Buckland ◽

Bryan M. Beaubrun ◽

Evan Isaacs ◽

John Moon ◽

Peter Zhou ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Lumbar Spine ◽

Magnetic Resonance ◽

Intervertebral Disc ◽

Interbody Fusion ◽

Lumbar Fusion ◽

Psoas Muscle ◽

Lumbar Interbody Fusion ◽

Resonance Imaging ◽

Lateral Lumbar Interbody Fusion

<sec><title>Study Design</title>Retrospective radiological review.</sec><sec><title>Purpose</title>To quantify the effect of sitting vs supine lumbar spine magnetic resonance imaging (MRI) and change in anterior displacement of the psoas muscle from L1–L2 to L4–L5 discs.</sec><sec><title>Overview of Literature</title>Controversy exists in determining patient suitability for lateral lumbar interbody fusion (LLIF) based on psoas morphology. The effect of posture on psoas morphology has not previously been studied; however, lumbar MRI may be performed in sitting or supine positions.</sec><sec><title>Methods</title>A retrospective review of a single-spine practice over 6 months was performed, identifying patients aged between 18–90 years with degenerative spinal pathologies and lumbar MRIs were evaluated. Previous lumbar fusion, scoliosis, neuromuscular disease, skeletal immaturity, or intrinsic abnormalities of the psoas muscle were excluded. The anteroposterior (AP) dimension of the psoas muscle and intervertebral disc were measured at each intervertebral disc from L1–L2 to L4–L5, and the AP psoas:disc ratio calculated. The morphology was compared between patients undergoing sitting and/or supine MRI.</sec><sec><title>Results</title>Two hundred and nine patients were identified with supine-, and 60 patients with sitting-MRIs, of which 13 patients had undergone both sitting and supine MRIs (BOTH group). A propensity score match (PSM) was performed for patients undergoing either supine or sitting MRI to match for age, BMI, and gender to produce two groups of 43 patients. In the BOTH and PSM group, sitting MRI displayed significantly higher AP psoas:disc ratio compared with supine MRI at all intervertebral levels except L1–L2. The largest difference observed was a mean 32%–37% increase in sitting AP psoas:disc ratio at the L4–L5 disc in sitting compared to supine in the BOTH group (range, 0%–137%).</sec><sec><title>Conclusions</title>The psoas muscle and the lumbar plexus become anteriorly displaced in sitting MRIs, with a greater effect noted at caudal intervertebral discs. This may have implications in selecting suitability for LLIF, and intra-operative patient positioning.</sec>

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Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

Neurosurgical FOCUS ◽

10.3171/2020.6.focus20361 ◽

2020 ◽

Vol 49 (3) ◽

pp. E11 ◽

Cited By ~ 1

Author(s):

Yoshifumi Kudo ◽

Ichiro Okano ◽

Tomoaki Toyone ◽

Akira Matsuoka ◽

Hiroshi Maruyama ◽

...

Keyword(s):

Revision Surgery ◽

Spinal Canal ◽

Interbody Fusion ◽

Decompression Surgery ◽

Complication Rates ◽

Lumbar Interbody Fusion ◽

Posterior Decompression ◽

Lateral Lumbar Interbody Fusion ◽

Significant Difference ◽

Dural Tears

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

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