Femoral Nerve Strain at L4–L5 Is Minimized by Hip Flexion and Increased by Table Break When Performing Lateral Interbody Fusion

O’Brien, Joseph R.; Haines, Colin M.; Dooley, Zachary A.; Turner, Alexander W.; Jackson, David S.

doi:10.1097/brs.0000000000000039

Cited by 30 publications

(13 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results show that when considering the trans-psoas and oblique approaches, sitting MRIs may dissuade surgeons from attempting an LLIF in specific patients. Flexion of the hips to 45–60 degrees intraoperatively has been advocated by O'Brien et al [ 16 ] in which they reported it would reduce strain in the lumbar plexus at the L4–L5 disc. This cadaveric study did not simulate lateral retractor placement in the psoas; however, the cadaveric lower extremity had been amputated mid-thigh.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

Study DesignRetrospective radiological review.PurposeTo 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.Overview of LiteratureControversy 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.MethodsA 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.ResultsTwo 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%).ConclusionsThe 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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Another documented risk in minimally invasive lateral approach was damage to the genitofemoral nerve [ 20 ]. A precise knowledge of the position of the genitofemoral nerve and performing an appropriate retraction might be critical to reduce this complication [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Does the Access Angle Change the Risk of Approach-Related Complications in Minimally Invasive Lateral Lumbar Interbody Fusion? An MRI Study

Huang

Zhang

et al. 2018

J Korean Neurosurg Soc

View full text Add to dashboard Cite

ObjectiveTo investigate the potential risk of approach-related complications at different access angles in minimally invasive lateral lumbar interbody fusion. MethodsEighty-six axial magnetic resonance images were obtained to analyze the risk of approach-related complications. The access corridor were simulated at different access angles and the potential risk of neurovascular structure injury was evaluated when the access corridor touching or overlapping the corresponding structures at each angle. Furthermore, the safe corridor length was measured when the corridor width was 18 and 22 mm. ResultsWhen access angle was 0°, the potential risk of ipsilateral nerve roots injury was 54.7% at L4–L5. When access angle was 45°, the potential risk of abdominal aorta, contralateral nerve roots or central canal injury at L4–L5 was 79.1%, 74.4%, and 30.2%, respectively. The length of the 18 mm-wide access corridor was largest at 0° and it could reach 44.5 mm at L3–L4 and 46.4 mm at L4–L5. While the length of the 22 mm-wide access corridor was 42.3 mm at L3–L4 and 44.1 mm at L4–L5 at 0°. ConclusionChanges in the access angle would not only affect the ipsilateral neurovascular structures, but also might adversely influence the contralateral neural elements. It should be also noted to surgeons that alteration of the access angle changed the corridor length.

show abstract

“…Lumbar plexus safety remained a concern. However, prone positioning with the hips neutral to extended seems to lengthen the psoas muscle and draw it and the plexus with it more posteriorly [ 13 , 14 ]. This, combined with a mid-disc initial docking and customized A-P exposure from there, have increased the authors’ comfort with access at L4–5.…”

Section: Methodsmentioning

confidence: 99%

Initial multi-centre clinical experience with prone transpsoas lateral interbody fusion: Feasibility, perioperative outcomes, and lessons learned

Smith¹,

Joseph²,

Ditty³

et al. 2021

North American Spine Society Journal (NASSJ)

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Femoral Nerve Strain at L4–L5 Is Minimized by Hip Flexion and Increased by Table Break When Performing Lateral Interbody Fusion

Abstract: N/A.

Cited by 30 publications

References 20 publications

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

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

Does the Access Angle Change the Risk of Approach-Related Complications in Minimally Invasive Lateral Lumbar Interbody Fusion? An MRI Study

Initial multi-centre clinical experience with prone transpsoas lateral interbody fusion: Feasibility, perioperative outcomes, and lessons learned

Contact Info

Product

Resources

About