Monitoring lumbar plexus integrity in extreme lateral transpsoas approaches to the lumbar spine: a new protocol with anatomical bases

Bendersky, Mariana; Solá, Carlos; Muntadas, Javier; Gruenberg, Marcelo; Calligaris, Silvana; Mereles, Maximiliano; Valacco, Marcelo; Bassani, Julio; Nicolás, Matías

doi:10.1007/s00586-015-3801-9

Cited by 26 publications

(17 citation statements)

References 36 publications

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“…This is posited to be a result of upper lumbar plexopathy secondary to stretch injury through retraction or sensory nerve injury on approach (50). Groin and thigh hyperesthesia is likely the result of injury to the iliohypogastric or ilioinguinal nerve during preparation through the abdominal wall with hyperesthesia usually spontaneously resolving (51).…”

Section: Complicationsmentioning

confidence: 99%

“…Dakwar et al (52) and Oliveira et al (53) reported transient postoperative anterior thigh numbness, ipsilateral to the side of approach in 12% and 14.3% of cases respectively. Short-term thigh dysthanasia and hip flexor weakness are well documented due to direct trauma to the psoas muscle yet quickly resolve in most cases (50). Longer psoas retraction time has been associated with lumbar plexopathy thought to be due to nerve compression and/or stretch (41).…”

Section: Complicationsmentioning

confidence: 99%

“…Longer psoas retraction time has been associated with lumbar plexopathy thought to be due to nerve compression and/or stretch (41). Bendersky et al (50) showed in their retrospective review that patients who had a retraction time of less than 20 minutes did not have lumbar plexopathy and it is widely recommended that retraction times be kept to a minimum, aiming to be less than 20−30 minutes © OSS Press Ltd. All rights reserved.…”

Section: Complicationsmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review

Winder¹,

Gambhir²

2016

J. Spine Surg.

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The incidence of lumbar fusion for the treatment of various degenerative lumbar spine diseases has increased dramatically over the last twenty years. Many lumbar fusion techniques have been developed and popularized, each with its own advantages and disadvantages. Anterior lumbar interbody fusion (ALIF) initially introduced in the 1930's, has become a common and widely accepted technique for lumbar fusions over the last decade offering several advantages over standard posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF). More recently, the lateral trans-psoas approach termed extreme, direct or lateral lumbar interbody fusion (XLIF, DLIF, LLIF) is gaining widespread popularity.The aim of this paper is to compare the approaches, advantages and disadvantages of ALIF and XLIF for L4/5 interbody fusion based on relevant literature.

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Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review

Winder¹,

Gambhir²

2016

J. Spine Surg.

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“…EMG monitoring throughout the surgical procedure is therefore mandatory. A new neurophysiological monitoring method that includes EMG and transpsoas stimulation to accurately evaluate the proximity of every branch of the lumbar plexus has been recently developed [29]. Indirect mechanisms may also contribute to determine a traction injury of the femoral nerve.…”

Section: Femoral Nervementioning

confidence: 99%

Lumbar plexus nervous distortion in XLIF® approach: an anatomic study

et al. 2016

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FN was in close connection with the deep psoas muscle fibers and it is subjected to anterior translation that correlates with TCK. This mechanism may partly explain the rate of femoral nerve palsy that occurs despite neuromonitoring and safe entry zones respect. The GN location at L4/L5 should be considered not only for its projection in Zone I, but also for its clock position on the psoas muscle surface, since it affects its distortion.

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“…However, the standard lateral approach, which traverses the psoas muscle (i.e., transpsoas approach), has its own limitations and complications (2)(3)(4)(5)(6). Of most concern is the potential for injury to the lumbar plexus, minimized by using intraoperative neuromonitoring (7). An alternative approach, anterior to psoas (ATP), without neuromonitoring, has been described (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Morphometric anatomy of the lumbar sympathetic trunk with respect to the anterolateral approach to lumbar interbody fusion: a cadaver study

Rutter¹,

Phan²,

Smith³

et al. 2017

J. Spine Surg.

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Background: An approach to lateral lumbar interbody fusion (LLIF) utilizing an oblique corridor anterior to the psoas muscle was first described by Mayer in 1997 and subsequently by other authors. The only consistent structure of note in this corridor is the lumbar sympathetic trunk (LST), which at times must be mobilized in order to perform a discectomy and interbody fusion, thereby placing the LST at risk. This study was designed to describe the morphometric anatomy of the LST in relation to surgically relevant landmarks for the anterolateral approach to the lumbar spine at L3/L4 to L5/S1.Methods: Twenty-four embalmed cadavers (13 males, 11 females, age range, 50-89) were dissected to expose the LST. Bilateral measurements were recorded using a calliper under direct visualization, using the midsagittal plane of the lumbar spine as the reference landmark. The points were then marked with radioopaque needles, and 14 cadavers were scanned with CT to validate the measurements.Results: Of 48 LSTs, there was minimal difference in the direction of its course between sides; 14/24 specimens had concordant directions. The majority (n=28) had a medial to lateral cephalocaudal course. If osteophytes were present at the L4/L5 level, the majority of LSTs (n=7, of 8) were displaced lateral to the osteophyte. At the L5/S1 level, half of the cases with osteophytes (n=3, of 6) stretched the LST over the top of the osteophyte. The LST was adherent to the L4/L5 disc space bilaterally in 93% of cases.Conclusions: With the development of lumbar fusion techniques which utilize an oblique corridor and the retraction of psoas muscle, LST has become an important neural structure to define, protect and mobilize.In our morphometric analysis of 24 specimens, the position has been identified and quantified, and this paper notes variations, particularly distortions caused by degenerative processes. In this study, the LST ran in a medial to lateral direction from L3 to S1, and osteophytes typically displace and adhere to the LST.

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Monitoring lumbar plexus integrity in extreme lateral transpsoas approaches to the lumbar spine: a new protocol with anatomical bases

Abstract: A detailed IOM of lumbar plexus branches can determine in real time the proximity of intrapsoas nerves during XLIF.

Cited by 26 publications

References 36 publications

Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review

Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review

Lumbar plexus nervous distortion in XLIF® approach: an anatomic study

Morphometric anatomy of the lumbar sympathetic trunk with respect to the anterolateral approach to lumbar interbody fusion: a cadaver study

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