Anatomic Considerations in the Lateral Transpsoas Interbody Fusion
| Autor: | Wellington K. Hsu, Andrew P. Alvarez, Sean M. Mitchell, Ryan D. Freshman, Sohaib Z. Hashmi, Charles Qin, Justin T. Smith, Andrew D. Schneider, Harry T. Mai |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Scoliosis Body Mass Index 03 medical and health sciences Sex Factors 0302 clinical medicine Lumbar medicine Humans Orthopedics and Sports Medicine Psoas Muscles 030222 orthopedics Lumbar Vertebrae Cobb angle medicine.diagnostic_test business.industry Age Factors Magnetic resonance imaging medicine.disease Magnetic Resonance Imaging Lumbosacral plexus Spinal Fusion Spinal fusion Female Surgery Lumbar spine Neurology (clinical) Radiology business Body mass index 030217 neurology & neurosurgery |
| Zdroj: | Clinical Spine Surgery: A Spine Publication. 32:215-221 |
| ISSN: | 2380-0186 |
| DOI: | 10.1097/bsd.0000000000000760 |
| Popis: | STUDY DESIGN This is a retrospective case series. OBJECTIVE Define the anatomic variations and the risk factors for such within the operative corridor of the transpsoas lateral interbody fusion. SUMMARY OF BACKGROUND DATA The lateral interbody fusion approach has recently been associated with devastating complications such as injury to the lumbosacral plexus, surrounding vasculature, and bowel. A more comprehensive understanding of anatomic structures in relation to this approach using preoperative imaging would help surgeons identify high-risk patients potentially minimizing these complications. MATERIALS AND METHODS Age-sex distributed, naive lumbar spine magnetic resonance imagings (n=180) were used to identify the corridor for the lateral lumbar interbody approach using axial images. Bilateral measurements were taken from L1-S1 to determine the locations of critical vascular, intraperitoneal, and muscular structures. In addition, a subcohort of scoliosis patients (n=39) with a Cobb angle >10 degrees were identified and compared. RESULTS Right-sided vascular anatomy was significantly more variant than left (9.9% vs. 5.7%; P=0.001). There were 9 instances of "at-risk" vasculature on the right side compared with 0 on the left (P=0.004). Age increased vascular anatomy variance bilaterally, particularly in the more caudal levels (P≤0.001). A "rising-psoas sign" was observed in 26.1% of patients. Bowel was identified within the corridor in 30.5% of patients and correlated positively with body mass index (P |
| Databáze: | OpenAIRE |
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