Direct Lateral Minimally Invasive Approach for Excision of a L1/L2 Neurofibroma—A Technical Note and Literature Review

Abstract

A case of resection of a large dumbbell-shaped nerve sheath tumor at L1/L2 via a direct lateral minimally invasive approach is described. The tumor was removed via a lateral, subdiaphragmatic, rib-sparing, retropleural, retroperitoneal approach. The thoracolumbar junction can be challenging via the lateral approach and to the best of our knowledge this is the first report of excision of a paravertebral tumor via this approach. We believe this provided the benefits of direct operative trajectory and exposure, excellent tumor access, and avoided the need for facetectomy and extended spinal instrumentation across the thoracolumbar junction. Complete tumor excision was achieved with preserved motor function and improvement in radicular pain and sensory neurological deficit.

Safe dissection and complication avoidance for L1–2 interbody placement via a lateral access approach

“…At L1–2, the psoas forms a thin muscular layer with contributors to the lumbar plexus, in particular the ilioinguinal and genitofemoral nerves, which may be injured when spreading the muscle. 4 Direct visualization of the psoas muscle and avoidance of these branches, if identified, provides for a safe retractor docking without injury to the nerves or other retroperitoneal contents. 5 …”