Endoscopic Lateral Transpsoas Approach to the Lumbar Spine

Bergey, Darren L.; Villavicencio, Alan T.; Goldstein, Theodore B.; Regan, John J.

doi:10.1097/01.brs.0000133643.75795.ef

Cited by 168 publications

(94 citation statements)

References 22 publications

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“…2,3,7,15 These tumors can be either intradural, extradural, or both. Rarely, these tumors arise within the lumbar plexus in the retroperitoneum as in this case.…”

Section: Discussionmentioning

confidence: 99%

“…7,8,13 A lateral transpsoas approach, as popularized in lateral interbody fusion surgery, is the most direct technique to approach retroperitoneal lumbar plexus tumors and should help to reduce postoperative pain and hospital stays and expedite the return to activities of daily living. [6][7][8][13][14][15] Furthermore, such an approach precludes the need for an access surgeon. 13 In this report, we describe a direct lateral minimally invasive approach to the retroperitoneum utilizing a tubular retractor and directional electromyography (EMG) for complete resection of an L4 nerve root schwannoma distal to the dorsal root ganglia in the psoas muscle.…”

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confidence: 99%

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Minimally Invasive Direct Lateral Transpsoas Approach for the Resection of a Lumbar Plexus Schwannoma: Technique Report

Benjamin¹,

Oermann²,

Thomas

et al. 2016

Surg J

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Objective Traditional techniques for resection of lumbar plexus tumors have been associated with approach-related morbidity. We describe a case utilizing a minimally invasive transpsoas lateral access approach to resect a retroperitoneal tumor of the lumbar plexus. Methods We report a case with an extradural retroperitoneal schwannoma of the L4 nerve root that was treated with a minimally invasive direct lateral transpsoas approach using atraumatic tissue dilators and an expandable tubular retractor. The use of directional and continuous electromyographic monitoring was critical in locating the plexus and positioning the retractor immediately anterior to the tumor. Results The patient tolerated the procedure well without postoperative complications. The operative approach was direct and intraoperative blood loss was negligible. The patient demonstrated improved left leg strength and ambulation and resolution of paresthesias. Conclusions A minimally invasive direct lateral transpsoas access approach is an effective technique to safely and adequately resect extradural retroperitoneal lumbar plexus tumors.

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“…2,3,7,15 These tumors can be either intradural, extradural, or both. Rarely, these tumors arise within the lumbar plexus in the retroperitoneum as in this case.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Minimally Invasive Direct Lateral Transpsoas Approach for the Resection of a Lumbar Plexus Schwannoma: Technique Report

Benjamin¹,

Oermann²,

Thomas

et al. 2016

Surg J

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“…The major unique risk is injury to the lumbar nerves as they exit the neural foramen and travel through the psoas muscle forming the lumbosacral plexus. This can lead to complications related to pain, neuropraxia, and weakness [3,15,32]. Recent studies have identified complication rates ranging from 6.2% to 52% [4, 7, 13-16, 20, 26, 27, 32-34, 36].…”

Section: Introductionmentioning

confidence: 99%

Complications of the Lateral Transpsoas Approach for Lumbar Interbody Arthrodesis: A Case Series and Literature Review

Sofianos

Briseño

Abrams

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background The lateral transpsoas approach to the lumbar spine was developed to eliminate the need for an anterior-approach surgeon and retraction of the great vessels and has the potential for shorter operative times. However, the reported complications associated with this approach vary. Questions/purposes We identified the incidence of complications associated with the lateral transpsoas approach to the lumbar spine. Patients and Methods We retrospectively reviewed 45 patients who underwent a lateral transpsoas approach to the spine for various diagnoses between January 1, 2006, and October 31, 2010. The patients' average age was 63.3 years. Sixteen (35.6%) patients had prior lumbar spinal surgery.Twenty-one patients (46.7%) underwent supplemental posterior instrumentation. Minimum followup was 0 months (mean, 11 months; range, 0-34 months). Results Eighteen of the 45 patients (40%) had complications: 10 (22.2%) developed postoperative iliopsoas weakness, three had quadriceps weakness, and one experienced foot drop. Eight patients (17.8%) developed anterior thigh hypoesthesia, which did not fully resolve in seven of the eight patients at an average of 9 months' followup. Three patients had postoperative radiculopathies, one a durotomy, and one died postoperatively from a pulmonary embolism. Conclusions We found a 40% incidence of complications and a nontrivial frequency and severity of postoperative weakness, numbness, and radicular pain in patients who underwent a lateral transpsoas approach to the spine. Given the expanding use of the approach, a thorough understanding of the risks associated with it is essential for patient education, medical decision making, and identifying methods of reducing such complications.

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“…4,9 One recent literature review has frequently been misreferenced to claim that motor weakness resulting from lumbar plexus injuries occurs in up to 33.6% of reported LLIF cases. 1 However, the purpose of the review was to advocate for a standardized classification of neurological findings after LLIF, and the motor weakness figure encompassed patients with transient iliopsoas weakness that occurs as results of muscle dissection by the retractor.…”

Section: Lumbar Plexus Risk From Lateral Access At L4-5mentioning

confidence: 99%

Minimally invasive anterior and lateral transpsoas approaches for closed reduction of grade II spondylolisthesis: initial clinical and radiographic experience

Bach

Uribe

2018

Neurosurgical Focus

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OBJECTIVEMinimally invasive anterior and lateral approaches to the lumbar spine are increasingly used to treat and reduce grade I spondylolisthesis, but concerns still exist for their usage in the management of higher-grade lesions. The authors report their experience with this strategy for grade II spondylolisthesis in a single-surgeon case series and provide early clinical and radiographic outcomes.METHODSA retrospective review of a single surgeon’s cases between 2012 and 2016 identified all patients with a Meyerding grade II lumbar spondylolisthesis who underwent minimally invasive lateral lumbar interbody fusion (LLIF) or anterior lumbar interbody fusion (ALIF) targeting the slipped level. Demographic, clinical, and radiographic data were collected and analyzed. Changes in radiographic measurements, Oswestry Disability Index (ODI), and visual analog scale (VAS) scores were compared using the paired t-test and Wilcoxon signed rank test for continuous and ordinal variables, respectively.RESULTSThe average operative time was 199.1 minutes (with 60.6 ml of estimated blood loss) for LLIFs and 282.1 minutes (with 106.3 ml of estimated blood loss), for ALIFs. Three LLIF patients had transient unilateral anterior thigh numbness during the 1st week after surgery, and 1 ALIF patient had transient dorsiflexion weakness, which was resolved at postoperative week 1. The mean follow-up time was 17.6 months (SD 12.5 months) for LLIF patients and 10 months (SD 3.1 months) for ALIF patients. Complete reduction of the spondylolisthesis was achieved in 12 LLIF patients (75.0%) and 7 ALIF patients (87.5%). Across both procedures, there was an increase in both the segmental lordosis (LLIF 5.6°, p = 0.002; ALIF 15.0°, p = 0.002) and overall lumbar lordosis (LLIF 2.9°, p = 0.151; ALIF 5.1°, p = 0.006) after surgery. Statistically significant decreases in the mean VAS and the mean ODI measurements were seen in both treatment groups. The VAS and ODI scores fell by a mean value of 3.9 (p = 0.002) and 19.8 (p = 0.001), respectively, for LLIF patients and 3.8 (p = 0.02) and 21.0 (p = 0.03), respectively, for ALIF patients at last follow-up.CONCLUSIONSEarly clinical and radiographic results from using minimally invasive LLIF and ALIF approaches to treat grade II spondylolisthesis appear to be good, with low operative blood loss and no neurological deficits. Complete reduction of the spondylolisthesis is frequently possible with a statistically significant reduction in pain scores.

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Endoscopic Lateral Transpsoas Approach to the Lumbar Spine

Cited by 168 publications

References 22 publications

Minimally Invasive Direct Lateral Transpsoas Approach for the Resection of a Lumbar Plexus Schwannoma: Technique Report

Minimally Invasive Direct Lateral Transpsoas Approach for the Resection of a Lumbar Plexus Schwannoma: Technique Report

Complications of the Lateral Transpsoas Approach for Lumbar Interbody Arthrodesis: A Case Series and Literature Review

Minimally invasive anterior and lateral transpsoas approaches for closed reduction of grade II spondylolisthesis: initial clinical and radiographic experience

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