IMAGING STUDY ON LUMBAR PLEXUS BY MINIMALLY INVASIVE LATERAL TRANSPSOAS APPROACH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HELei , XIEPeigen , CHENRuiqiang , SHUTao , ZHANGLiangming , FENGFeng ,  RONGLimin

Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510635, P.R.China;

Corresponding author：

RONGLimin, Email: ronglm21@163.com

Keywords：

Extreme lateral interbody fusion; Lumbar plexus; Magnetic resonance imaging; Lumbar vertebra

DOI：

10.7507/1002-1892.20160291

Video：

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Objective To analyze the relative position between lumbar plexus and access corridor of minimally invasive lateral transpsoas approach based on magnetic resonance imaging distribution of lumbar plexus by three dimensional reconstruction technique, so as to evaluate approach safety. Methods Three-dimensional fast imaging employing steady-state acquisition sequences of lumbar spine were performed on 71 patients with lumbar degenerative diseases between July 2012 and January 2015. The axial image distance between the anterior edge of lumbar plexus and sagittal central perpendicular line (SCPL) of disc was determined using the distance formula at the mid-disc space from L_{1, 2} to L_{4, 5} level. SCPL was drawn perpendicularly to the sagittal plane of intervertebral disc and it passed through its central point, which is initial dilator trajectory for transpsoas approach. With respect to the SCPL of disc, the distance with a positive value indicated neural tissue posterior to it whereas anterior to it represented by a negative value. Results Various branches of lumbar plexus which passed through the psoas major anterior to the SCPL of disc were identified in 42 (59.2%), 58 (81.7%), and 70 (98.6%) patients at L_{2, 3}, L_{3, 4}, and L_{4, 5} levels, respectively. It is possible to infer the presence of genitofemoral nerve in accordance with relevant anatomic research. A ventral migration of intrapsoas nerves is identified from L_{1, 2} to L_{4, 5} level. All differences between levels were statistically significant (P < 0.05). Conclusion With respect to the SCPL of disc, a pass way of guide wire or a radiographic reference landmark to place working channel, lumbar plexus lie posterior to it from L_{1, 2} to L_{3, 4} level and shift anteriorly to it at L_{4, 5} level, while genitofemoral nerve locate anterior to the SCPL from L_{2, 3} to L_{4, 5} level. Neural retraction may take place during sequential dilation of working channel especially at L_{4, 5} level.

Citation： HELei, XIEPeigen, CHENRuiqiang, SHUTao, ZHANGLiangming, FENGFeng, RONGLimin. IMAGING STUDY ON LUMBAR PLEXUS BY MINIMALLY INVASIVE LATERAL TRANSPSOAS APPROACH. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(11): 1412-1416. doi: 10.7507/1002-1892.20160291 Copy

1.	Ozgur BM, Aryan HE, Pimenta L, et al. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J, 2006, 6(4): 435-443.
2.	Pawar AY, Hughes AP, Sama AA, et al. A comparative study of lateral lumbar interbody fusion and posterior lumbar interbody fusion in degenerative lumbar spondylolisthesis. Asian Spine J, 2015, 9(5): 668-674.
3.	Sembrano JN, Tohmeh A, Isaacs R. Two-year comparative outcomes of mis lateral and mis transforaminal interbody fusion in the treatment of degenerative spondylolisthesis: Part I: clinical findings. Spine (Phila Pa 1976), 2016, 41 Suppl 8: S123-132.
4.	Uribe JS, Deukmedjian AR. Visceral, vascular, and wound complications following over 13, 000 lateral interbody fusions: a survey study and literature review. Eur Spine J, 2015, 24 Suppl 3: 386-396.
5.	Joseph JR, Smith BW, La Marca F, et al. Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature. Neurosurg Focus, 2015, 39(4): E4.
6.	Uribe JS, Arredondo N, Dakwar E, et al. Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study. J Neurosurg Spine, 2010, 13(2): 260-266.
7.	Kepler CK, Bogner EA, Herzog RJ, et al. Anatomy of the psoas muscle and lumbar plexus with respect to the surgical approach for lateral transpsoas interbody fusion. Eur Spine J, 2011, 20(4): 550-556.
8.	Hu WK, He SS, Zhang SC, et al. An MRI study of psoas major and abdominal large vessels with respect to the X/DLIF approach. Eur Spine J, 2011, 20(4): 557-562.
9.	Guérin P, Obeid I, Gille O, et al. Safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: a morphometric study. Surg Radiol Anat, 2011, 33(8): 665-671.
10.	Kulkarni M. Constructive interference in steady-state/FIESTA-C clinical applications in neuroimaging. J Med Imaging Radiat Oncol, 2011, 55(2): 183-190.
11.	Shishido H, Takashima H, Takebayashi T, et al. Visualization of the foramen intervertebral nerve root of cervical spine with 3.0 tesla magnetic resonance imaging: a comparison of three-dimensional acquisition techniques. Nihon Hoshasen Gijutsu Gakkai Zasshi, 2014, 70(7): 670-675.
12.	Nemoto O, Fujikawa A, Tachibana A. Three-dimensional fast imaging employing steady-state acquisition MRI and its diagnostic value for lumbar foraminal stenosis. Eur J Orthop Surg Traumatol, 2014, 24 Suppl 1: S209-214.
13.	Isaacs RE, Sembrano JN, Tohmeh AG. Two-year comparative outcomes of MIS lateral and mis transforaminal interbody fusion in the treatment of degenerative spondylolisthesis: Part II: radiographic findings. Spine (Phila Pa 1976), 2016, 41 Suppl 8: S133-144.
14.	Lykissas MG, Aichmair A, Hughes AP, et al. Nerve injury after lateral lumbar interbody fusion: a review of 919 treated levels with identification of risk factors. Spine J, 2014, 14(5): 749-758.
15.	Le TV, Smith DA, Greenberg MS, et al. Complications of lateral plating in the minimally invasive lateral transpsoas approach. J Neurosurg Spine, 2012, 16(3): 302-307.
16.	Tohmeh AG, Rodgers WB, Peterson MD. Dynamically evoked, discrete-threshold electromyography in the extreme lateral interbody fusion approach. J Neurosurg Spine, 2011, 14(1): 31-37.
17.	Uribe JS, Vale FL, Dakwar E. Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S368-374.
18.	Kotwal S, Kawaguchi S, Lebl D, et al. Minimally Invasive Lateral Lumbar Interbody Fusion: Clinical and Radiographic Outcome at a Minimum 2-year Follow-up. J Spinal Disord Tech, 2015, 28(4): 119-125.
19.	Berjano P, Gautschi OP, Schils F, et al. Extreme lateral interbody fusion (XLIF®): how I do it. Acta Neurochir (Wien), 2015, 157(3): 547-551.
20.	Regev GJ, Chen L, Dhawan M, et al. Morphometric analysis of the ventral nerve roots and retroperitoneal vessels with respect to the minimally invasive lateral approach in normal and deformed spines. Spine (Phila Pa 1976), 2009, 34(12): 1330-1335.

1. Ozgur BM, Aryan HE, Pimenta L, et al. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J, 2006, 6(4): 435-443.
2. Pawar AY, Hughes AP, Sama AA, et al. A comparative study of lateral lumbar interbody fusion and posterior lumbar interbody fusion in degenerative lumbar spondylolisthesis. Asian Spine J, 2015, 9(5): 668-674.
3. Sembrano JN, Tohmeh A, Isaacs R. Two-year comparative outcomes of mis lateral and mis transforaminal interbody fusion in the treatment of degenerative spondylolisthesis: Part I: clinical findings. Spine (Phila Pa 1976), 2016, 41 Suppl 8: S123-132.
4. Uribe JS, Deukmedjian AR. Visceral, vascular, and wound complications following over 13, 000 lateral interbody fusions: a survey study and literature review. Eur Spine J, 2015, 24 Suppl 3: 386-396.
5. Joseph JR, Smith BW, La Marca F, et al. Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature. Neurosurg Focus, 2015, 39(4): E4.
6. Uribe JS, Arredondo N, Dakwar E, et al. Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study. J Neurosurg Spine, 2010, 13(2): 260-266.
7. Kepler CK, Bogner EA, Herzog RJ, et al. Anatomy of the psoas muscle and lumbar plexus with respect to the surgical approach for lateral transpsoas interbody fusion. Eur Spine J, 2011, 20(4): 550-556.
8. Hu WK, He SS, Zhang SC, et al. An MRI study of psoas major and abdominal large vessels with respect to the X/DLIF approach. Eur Spine J, 2011, 20(4): 557-562.
9. Guérin P, Obeid I, Gille O, et al. Safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: a morphometric study. Surg Radiol Anat, 2011, 33(8): 665-671.
10. Kulkarni M. Constructive interference in steady-state/FIESTA-C clinical applications in neuroimaging. J Med Imaging Radiat Oncol, 2011, 55(2): 183-190.
11. Shishido H, Takashima H, Takebayashi T, et al. Visualization of the foramen intervertebral nerve root of cervical spine with 3.0 tesla magnetic resonance imaging: a comparison of three-dimensional acquisition techniques. Nihon Hoshasen Gijutsu Gakkai Zasshi, 2014, 70(7): 670-675.
12. Nemoto O, Fujikawa A, Tachibana A. Three-dimensional fast imaging employing steady-state acquisition MRI and its diagnostic value for lumbar foraminal stenosis. Eur J Orthop Surg Traumatol, 2014, 24 Suppl 1: S209-214.
13. Isaacs RE, Sembrano JN, Tohmeh AG. Two-year comparative outcomes of MIS lateral and mis transforaminal interbody fusion in the treatment of degenerative spondylolisthesis: Part II: radiographic findings. Spine (Phila Pa 1976), 2016, 41 Suppl 8: S133-144.
14. Lykissas MG, Aichmair A, Hughes AP, et al. Nerve injury after lateral lumbar interbody fusion: a review of 919 treated levels with identification of risk factors. Spine J, 2014, 14(5): 749-758.
15. Le TV, Smith DA, Greenberg MS, et al. Complications of lateral plating in the minimally invasive lateral transpsoas approach. J Neurosurg Spine, 2012, 16(3): 302-307.
16. Tohmeh AG, Rodgers WB, Peterson MD. Dynamically evoked, discrete-threshold electromyography in the extreme lateral interbody fusion approach. J Neurosurg Spine, 2011, 14(1): 31-37.
17. Uribe JS, Vale FL, Dakwar E. Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S368-374.
18. Kotwal S, Kawaguchi S, Lebl D, et al. Minimally Invasive Lateral Lumbar Interbody Fusion: Clinical and Radiographic Outcome at a Minimum 2-year Follow-up. J Spinal Disord Tech, 2015, 28(4): 119-125.
19. Berjano P, Gautschi OP, Schils F, et al. Extreme lateral interbody fusion (XLIF®): how I do it. Acta Neurochir (Wien), 2015, 157(3): 547-551.
20. Regev GJ, Chen L, Dhawan M, et al. Morphometric analysis of the ventral nerve roots and retroperitoneal vessels with respect to the minimally invasive lateral approach in normal and deformed spines. Spine (Phila Pa 1976), 2009, 34(12): 1330-1335.

Chinese Journal of Reparative and Reconstructive Surgery

IMAGING STUDY ON LUMBAR PLEXUS BY MINIMALLY INVASIVE LATERAL TRANSPSOAS APPROACH

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