The Subcostal Nerve During Lateral Approaches to the Lumbar Spine: An Anatomical Study with Relevance for Injury Avoidance and Postoperative Complications Such as Abdominal Wall Hernia

Alonso, Fernando; Graham, Rachel A.; Rustagi, Tarush; Drazin, Doniel; Loukas, Marios; Oskouian, Rod J.; Tubbs, R. Shane

doi:10.1016/j.wneu.2017.05.055

Cited by 24 publications

(13 citation statements)

References 20 publications

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“…3 The likely explanation for delayed hernia, has been described due to diferent etiologies, such as the muscular atrophy follow by iatrogenic denervation during the disection of the abdominal wall muscles, even the incidental nerve section while clousin the surgical wound or the use of electrocauterium. 12 The muscles lose their integrity following denervation and atrophy, and the abdominal wall allows the herniation. Hence blunt and careful dissection of muscular layers is recommended to prevent denervation and subsequent atrophy.…”

Section: Discussionmentioning

confidence: 99%

Hernia incisional, una complicación poco frecuente del abordaje transpsoas anterolateral

Reyes-Sánchez¹,

Valenzuela-González²,

Valle-Valdez³

et al. 2020

Acta Ortopédica Mexicana

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Introduction: Anterolateral transpsoas approach is considered as safe access to the retroperitoneum with low risk of complications. The most frequent described complications due to this approach were nerve, bowel, urethral and kidney injury. An incisional hernia is a rare complication in anterolateral approach, as a result of a nonhealing surgical wound or late disruption of the fascia; it occurs in 1% of the incisions after primary closure. Case description: We report a 75-year-old woman who underwent spinal surgery with a double approach, consisting of an anterolateral transpsoas approach and posterior lumbar approach. Two months post-surgery, the patient developed a lateral abdominal tumor at the surgical site. Conclusion: To prevent incisional hernia, a meticulous dissection must be performed to avoid muscle denervation and weakening of the abdominal wall, as well as proper repair of the fascia its critical to ensure an adequate closure of the wound.

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Section: Discussionmentioning

confidence: 99%

Hernia incisional, una complicación poco frecuente del abordaje transpsoas anterolateral

Reyes-Sánchez¹,

Valenzuela-González²,

Valle-Valdez³

et al. 2020

Acta Ortopédica Mexicana

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“…[10] In a recent study by Alonso et al ., the subcostal nerve was described as larger, covering a wider area with more branches (8 on average as opposed to 4 of the L1) and travels 5 cm below the 12 th rib in its initial course. [11] Beneath the rib, the nerve either travels anterior or inferior to the lumbocostal ligament[12] or even pierces it. [13] The nerve was also identifiable by ultrasound.…”

Section: Discussionmentioning

confidence: 99%

The subcostal nerve as the target for nerve stimulator guided transverse abdominis plane blocks – A feasibility study

2019

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Background and Aims: Transverse Abdominis Plane (TAP) block was originally described as a landmark-based technique. Peripheral nerve stimulator (PNS) guided blocks are still widely performed, where ultrasound is unavailable. Methods: Cadaveric dissections were performed which showed the subcostal nerve following a predictable course at the lateral abdominal wall in the TAP. The subcostal nerve was identified by ultrasound in three volunteers. Stimulation of the subcostal nerve was performed using PNS and landmarks as guidance in and 20 patients. Twitches of the anterior abdominal wall muscles were elicited, and needle position and drug dispersion were confirmed using ultrasound. Results: Out of 32 attempts made, the drug dispersion was appropriate in 24, not appropriate on four insertions and twitches were not elicited in 4 attempts. Conclusion: Nerve stimulator can be used as a guidance for TAP blocks where the availability of ultrasound is limited.

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“…1,7 The subcostal nerve innervates the rectus abdominis, the transversus abdominis, and the inferior portion of the external oblique muscles. 1,7 In their comprehensive cadaveric and electrophysiological study, Fahim et al 7 demonstrated that the 11th intercostal and 12th sub-costal nerves are the predominant innervation to the anterolateral abdominal musculature. The authors reported 3 anatomical zones along the course of these nerves and proposed mechanisms for nerve injury during surgery.…”

Section: Discussionmentioning

confidence: 99%

Subcostal nerve injury after laparoscopic lipoma surgery: an unusual culprit for an unusual complication

Abou‐Al‐Shaar

Mahan

2019

Journal of Neurosurgery

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Endoscopic surgery has revolutionized the field of minimally invasive surgery. Nerve injury after laparoscopic surgery is presumably rare, with only scarce reports in the literature; however, the use of these techniques for new purposes presents the opportunity for novel complications. The authors report a case of subcostal nerve injury after an anterior laparoscopic approach to a posterior abdominal wall lipoma.A 62-year-old woman presented with a left abdominal flank bulge (pseudohernia) that developed after laparoscopic posterior flank wall lipoma resection. Imaging demonstrated frank ballooning of the oblique muscles; denervation atrophy and thinning of the external oblique, internal oblique, and transverse abdominis muscles; and thinning of the rectus abdominis muscle. The patient underwent subcostal nerve repair and removal of a foreign plastic material from the laparoscopic procedure. At 8 months, she has regained substantial improvement in abdominal wall strength.Although endoscopic procedures have resulted in significant reduction in morbidity, “minimally invasive” approaches should not be confused with “low risk” when approaching novel pathology. The subcostal nerve is at risk of injury in posterior abdominal wall surgery, whether laparoscopic or not. With the pseudohernia and abdominal bulge after this surgery, the cosmetic appeal of laparoscopic incisions was definitively undone. Selecting an approach based on the anatomy of adjacent structures may lead to a better functional result.

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The Subcostal Nerve During Lateral Approaches to the Lumbar Spine: An Anatomical Study with Relevance for Injury Avoidance and Postoperative Complications Such as Abdominal Wall Hernia

Cited by 24 publications

References 20 publications

Hernia incisional, una complicación poco frecuente del abordaje transpsoas anterolateral

Hernia incisional, una complicación poco frecuente del abordaje transpsoas anterolateral

The subcostal nerve as the target for nerve stimulator guided transverse abdominis plane blocks – A feasibility study

Subcostal nerve injury after laparoscopic lipoma surgery: an unusual culprit for an unusual complication

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