caa a22 4500 445833904 CHVBK 20180317145324.0 cr unu---uuuuu 170323e20110401xx s 000 0 eng 10.1007/s00586-010-1593-5 doi (NATIONALLICENCE)springer-10.1007/s00586-010-1593-5 Anatomy of the psoas muscle and lumbar plexus with respect to the surgical approach for lateral transpsoas interbody fusion [Elektronische Daten] [Christopher Kepler, Eric Bogner, Richard Herzog, Russel Huang] Lateral transpsoas interbody fusion (LTIF) is a minimally invasive technique that permits interbody fusion utilizing cages placed via a direct lateral retroperitoneal approach. We sought to describe the locations of relevant neurovascular structures based on MRI with respect to this novel surgical approach. We retrospectively reviewed consecutive lumbosacral spine MRI scans in 43 skeletally mature adults. MRI scans were independently reviewed by two readers to identify the location of the psoas muscle, lumbar plexus, femoral nerve, inferior vena cava and right iliac vein. Structures potentially at risk for injury were identified by: a distance from the anterior aspect of the adjacent vertebral bodies of <20mm, representing the minimum retraction necessary for cage placement, and extension of vascular structures posterior to the anterior vertebral body, requiring anterior retraction. The percentage of patients with neurovascular structures at risk for left-sided approaches was 2.3% at L1-2, 7.0% at L2-3, 4.7% at L3-4 and 20.9% at L4-5. For right-sided approaches, this rose to 7.0% at L1-2, 7.0% at L2-3, 9.3% at L3-4 and 44.2% at L4-5, largely because of the relatively posterior right-sided vasculature. A relationship between the position of psoas muscle and lumbar plexus is described which allows use of the psoas position as a proxy for lumbar plexus position to identify patients who may be at risk, particularly at the L4-5 level. Further study will establish the clinical relevance of these measurements and the ability of neurovascular structures to be retracted without significant injury. Springer-Verlag, 2010 Lateral transpsoas interbody fusion nationallicence Minimally invasive surgery nationallicence Lumbar plexus anatomy nationallicence Spine surgery complications nationallicence Kepler Christopher Spine and Scoliosis Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut Bogner Eric Department of Radiology, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut Herzog Richard Department of Radiology, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut Huang Russel Spine and Scoliosis Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut European Spine Journal Springer-Verlag 20/4(2011-04-01), 550-556 0940-6719 20:4<550 2011 20 586 https://doi.org/10.1007/s00586-010-1593-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00586-010-1593-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kepler Christopher Spine and Scoliosis Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut NATIONALLICENCE 700 1- Bogner Eric Department of Radiology, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut NATIONALLICENCE 700 1- Herzog Richard Department of Radiology, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut NATIONALLICENCE 700 1- Huang Russel Spine and Scoliosis Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut NATIONALLICENCE 773 0- European Spine Journal Springer-Verlag 20/4(2011-04-01), 550-556 0940-6719 20:4<550 2011 20 586 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer