Complication management with minimally invasive spine procedures

Hussain, Namath; Perez-Cruet, Mick J.

doi:10.3171/2011.8.focus11165

Cited by 30 publications

(19 citation statements)

References 25 publications

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“…MIS ap- proaches allow for smaller incisions and shorter operating time, which often results in less postoperative pain, less morbidity, shorter hospital stay, and faster recovery. 8,10,15,21 Anterior, transforaminal, lateral transpsoas, transsacral, and oblique MIS approaches have been described for access to the intervertebral discs and anterior spine.…”

Section: Discussionmentioning

confidence: 99%

“…There is a risk of bowel injury, especially in patients with abdominal adhesions and other abdominal pathology. 15,27 The lateral transpsoas MIS approach, first described by Pimenta et al, does not require an access surgeon and allows for access to the spine without the need to mobilize the great vessels or sympathetic nerves. 19,23,33 Access to the spine is gained through a far-lateral incision that enters the retroperitoneal space and requires dissection through the psoas muscle.…”

Section: 1019mentioning

confidence: 99%

“…14,21,33 The transpsoas approach does, however, pose risk to neural structures of the lumbar plexus as they course through the psoas. 2,12,13,15,21 The large muscle belly of the psoas and overlap of the iliac crest make access to the L4-5 disc difficult and eliminate access to the L5-S1 disc. 2,3,8,10,15 Access to the L4-5 disc in a lateral transpsoas approach often requires a table break or jack-knifed table position to lower the ipsilateral iliac crest.…”

mentioning

confidence: 99%

“…2,12,13,15,21 The large muscle belly of the psoas and overlap of the iliac crest make access to the L4-5 disc difficult and eliminate access to the L5-S1 disc. 2,3,8,10,15 Access to the L4-5 disc in a lateral transpsoas approach often requires a table break or jack-knifed table position to lower the ipsilateral iliac crest. Access to the L5-S1 intervertebral disc usually requires repositioning of the patient and adopting an alternative approach.…”

mentioning

confidence: 99%

“…Access to the L5-S1 intervertebral disc usually requires repositioning of the patient and adopting an alternative approach. 2,15,27 The purpose of this study is to investigate the MIS oblique access corridor to the L2-S1 intervertebral discs in a right lateral decubitus position without table break.…”

mentioning

confidence: 99%

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Retroperitoneal oblique corridor to the L2–S1 intervertebral discs in the lateral position: an anatomic study

Davis

Hynes²,

Fung

et al. 2014

SPI

165

145

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Object Access to the intervertebral discs from L2–S1 in one surgical position can be challenging. The transpsoas minimally invasive surgical (MIS) approach is preferred by many surgeons, but this approach poses potential risk to neural structures of the lumbar plexus as they course through the psoas. The lumbar plexus and iliac crest often restrict the L4–5 disc access, and the L5–S1 level has not been a viable option from a direct lateral approach. The purpose of the present study was to investigate an MIS oblique corridor to the L2–S1 intervertebral disc space in cadaveric specimens while keeping the specimens in a lateral decubitus position with minimal disruption of the psoas and lumbar plexus. Methods Twenty fresh-frozen full-torso cadaveric specimens were dissected, and an oblique anatomical corridor to access the L2–S1 discs was examined. Measurements were taken in a static state and with mild retraction of the psoas. The access corridor was defined at L2–5 as the left lateral border of the aorta (or iliac artery) and the anterior medial border of the psoas. The L5–S1 corridor of access was defined transversely from the midsagittal line of the inferior endplate of L-5 to the medial border of the left common iliac vessel and vertically to the first vascular structure that crosses midline. Results The mean access corridor diameters in the static state and with mild psoas retraction, respectively, were as follows: at L2–3, 18.60 mm and 25.50 mm; at L3–4, 19.25 mm and 27.05 mm; and at L4–5, 15.00 mm and 24.45 mm. The L5–S1 corridor mean values were 14.75 mm transversely, from midline to the left common iliac vessel and 23.85 mm from the inferior endplate of L-5 cephalad to the first midline vessel. Conclusions The oblique corridor allows access to the L2–S1 discs while keeping the patient in a lateral decubitus position without a break in the table. Minimal psoas retraction without significant tendon disruption allowed for a generous corridor to the disc space. The L5–S1 disc space can be accessed from an oblique angle consistently with gentle retraction of the iliac vessels. This study supports the potential of an MIS oblique retroperitoneal approach to the L2–S1 discs.