Lateral Interbody Fusion at L4/5: Management of the Transitional Psoas
| Autor: | Soumya Sagar, Ifije E. Ohiorhenuan, Joshua T. Wewel, Juan S. Uribe, Nikolay L. Martirosyan |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Lumbosacral Plexus 03 medical and health sciences 0302 clinical medicine Lumbar interbody fusion medicine Humans In patient Prospective Studies Contraindication Aged Psoas Muscles Retrospective Studies Aged 80 and over Lumbar Vertebrae Lumbar plexus business.industry digestive oral and skin physiology Disease Management Middle Aged medicine.disease Spondylolisthesis Surgery Oswestry Disability Index Vertebral body Spinal Fusion 030220 oncology & carcinogenesis Female Spinal Diseases Neurology (clinical) business 030217 neurology & neurosurgery Preoperative imaging |
| Zdroj: | World Neurosurgery. 148:e192-e196 |
| ISSN: | 1878-8750 |
| Popis: | Objective Managing retraction of the lumbar plexus is critical to safely perform lateral lumbar interbody fusion (LLIF) via the transpsoas approach. Occasionally, a transitional psoas is encountered at L4/5 and has been postulated to be a contraindication to transpsoas LLIF. A case series of patients with transitional psoas who underwent L4/5 LLIFs is presented. Methods This retrospective review assessed 79 consecutive patients who underwent L4/5 LLIF during a 24-month period. Preoperative imaging was reviewed, and patients were classified into 2 groups: normal psoas or transitional psoas. Intraoperative features and outcomes were compared between groups. Results Seventy-nine patients underwent L4/5 LLIFs, of whom 23 had transitional psoas anatomy and 56 had normal psoas anatomy. Among patients with transitional psoas, the center of the psoas was a mean (range) of 11.2 (5.2–26.6) mm in front of the center of the vertebral body compared with 2.0 (0–4) mm in the normal psoas group. The mean (range) retraction time was similar between groups (10.8 [6.7–14.9] minutes in the transitional psoas group vs. 11.0 [7.8–15.0] minutes in the normal psoas group). No permanent motor injuries occurred in either group, and no differences in length of stay or preoperative or postoperative Oswestry Disability Index scores were found between the groups. The protocol for L4/5 LLIF in patients with transitional psoas anatomy is described. Conclusions Transitional psoas anatomy is frequently encountered in surgical candidates for L4/5 LLIF. Through careful identification of the lumbar plexus and judicious retraction, the transpsoas LLIF can safely be performed in these patients. |
| Databáze: | OpenAIRE |
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