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

Iwanaga, Joe; Zeoli, Tyler; Scullen, Tyler; Maulucci, Christopher M.; Tubbs, R. Shane

doi:10.7759/cureus.14346

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…These are located in the extraperitoneal connective tissue on the anterolateral surface of the lumbar spine, along the medial edge of the psoas major (Murata et al, 2003; Standring, 2016). Iwanaga, Zeoli, et al (2021) reported a case where an experienced spine surgeon demonstrated a far lateral interbody fusion operation on a cadaver. After the operation, the lumbar sympathetic nerve was completely transectedat the L3 vertebral body level.…”

Section: Discussionmentioning

confidence: 99%

Position of lumbar plexus nerves in the psoas major: Application to transpsoas approaches to the lumbar spine

et al. 2023

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Far lateral interbody fusion is a minimally invasive operating technique. However, the incidence of postoperative neurological complications is high, and some scholars question its safety. This study describes the neuroanatomical features and spatial orientation within the psoas major. Ten embalmed male cadavers were selected and the left psoas major was dissected. Subsequently, the area between the anterior and the posterior edges of the vertebral body was divided into three equal zones. The nerves' distribution, number, and spatial orientation of the L1/2 to L4/5 intervertebral discs were examined. A caliper was used to measure the diameter of the nerve. The safety zone of the L1/2 intervertebral disc level is located in zone I and II, the relative safe zones of the L2/3 and L4/5 intervertebral discs are located in zone II, and the safety zone of the L3/4 intervertebral disc level is located in the caudal side of zone II. The genitofemoral nerve exits the psoas major in a co‐trunk or two‐branch pattern, and its exit point was distributed between the L3 and L4 vertebral bodies, mainly at the L3/4 intervertebral disc level. The sympathetic ganglia in the psoas major appeared only in zone I at the L2/3 intervertebral disc level. This is a systematic anatomical study that describes the nerves of the psoas major. Spine surgeons can use this study—which consists of important clinical implications—for preoperative planning, and thus, reduce the risk of nerve injury during surgery.

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Section: Discussionmentioning

confidence: 99%

Position of lumbar plexus nerves in the psoas major: Application to transpsoas approaches to the lumbar spine

et al. 2023

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Risk factors for postoperative sympathetic chain dysfunction following oblique lateral lumbar interbody fusion: a multivariate analysis

Zhao¹,

Hou²,

Shi³

et al. 2023

Eur Spine J

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

Abstract: Iwanaga et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 2 publications

References 16 publications

Position of lumbar plexus nerves in the psoas major: Application to transpsoas approaches to the lumbar spine

Position of lumbar plexus nerves in the psoas major: Application to transpsoas approaches to the lumbar spine

Risk factors for postoperative sympathetic chain dysfunction following oblique lateral lumbar interbody fusion: a multivariate analysis

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