Abstract:
STUDY DESIGN:Cadaveric study. OBJECTIVE:Identifying anatomic structures at risk for injury during direct lateral transpsoas approach to the spine. SUMMARY OF BACKGROUND DATA:Direct lateral transpsoas approach is a novel technique that has been described for anterior lumbar interbody fusion. Potential risks include damage to genitofemoral nerve and lumbar plexus, which are not well visualized during small retroperitoneal exposure. Previous cadaveric studies did not evaluate the direct lateral transpsoas approach, and considering the approach being used in clinical practice, the current study was undertaken in an effort to identify the structures at risk during direct lateral transpsoas approach. METHODS:Sixteen dissections were performed on eight fresh-frozen male cadavers. Eight were to localize proximal lumbar nerve roots, ilioinguinal nerves, and genitofemoral nerves and establish their relationship to psoas muscle and disc space. Four simulated direct lateral transpsoas approaches, with K-wire placed into mid-disc space under fluoroscopic guidance, were made. In four dissections, sequential dilators were inserted, disc space was evacuated, and interbody devices were placed. The study was conducted in three phases to identify, in a stepwise progression, which portion of the procedure placed the nerve at greatest risk. RESULTS.: With initial dissections, perforating branches of lumbar nerve roots were identified in anterior, middle, and posterior third of psoas muscle. Sympathetic chain was identified in anterior third of psoas over L1-L4. Distance from the middle of the anterior longitudinal ligament at the level of the disc to the sympathetic chain averaged 9.25 mm. The nerve roots and genitofemoral nerve were placed at risk in all dissections in which the approach was recreated. Damage secondary to K-wire placement occurred in 25% of cases at L3-L4 and L4-L5; in one case, L4 nerve root was pierced, and in another, genitofemoral nerve was pierced. K-wire was posterior to the nerve roots in 25% of cases at L3-L4 and in 50% of cases at L4-L5. The lumbar plexus was placed under tension because of sequential dilator placement. CONCLUSION:On the basis of our results, there is no zone of absolute safety when using the direct lateral transpsoas approach. The potential for nerve injury exists when using this approach, and consequently, we recommend either direct visualization of the nerve roots intraoperatively and/or the use of neuromonitoring. In our opinion, a higher quality, larger clinical study that examines the outcomes and surgical complications of the direct lateral transpsoas approach is warranted.
journal_name
Spine (Phila Pa 1976)journal_title
Spineauthors
Banagan K,Gelb D,Poelstra K,Ludwig Sdoi
10.1097/BRS.0b013e3181ec5911subject
Has Abstractpub_date
2011-05-15 00:00:00pages
E687-91issue
11eissn
0362-2436issn
1528-1159journal_volume
36pub_type
杂志文章相关文献
SPINE文献大全abstract:STUDY DESIGN:An in vitro study using ovine intervertebral discs to correlate the effects of increasing advanced glycation end-products (AGEs) with disc hydration evaluated by magnetic resonance imaging (MRI). OBJECTIVE:To determine the relationship between the level of AGEs and tissue water content in intervertebral d...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e31822ce81f
更新日期:2012-02-15 00:00:00
abstract:STUDY DESIGN:Retrospective review. OBJECTIVE:To assess the effectiveness of apical lordosating osteotomy (ALO) and minimal segment fixation through a posterior approach for correcting thoracic or thoracolumbar osteoporotic kyphosis (OK). SUMMARY OF BACKGROUND DATA:Current surgical options for OK involve a risk of com...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/01.brs.0000170450.77554.bc
更新日期:2005-07-15 00:00:00
abstract:STUDY DESIGN:In vitro cadaveric study. OBJECTIVE:The purpose of this study was to quantify the relative biomechanical protection resulting from "saving a level" in long spinal fusions. SUMMARY OF BACKGROUND DATA:"Saving levels" in spinal deformity surgery is desirable. Constructs with lowest instrumented vertebra (LI...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e31821e1106
更新日期:2012-03-01 00:00:00
abstract:STUDY DESIGN:A retrospective study was performed of 182 revisions on failed back surgery syndrome from the years 1965 to 1990. OBJECTIVE:To analyze the reasons for failure of primary discectomy, the outcome of the revisions, and factors that influenced those outcomes. SUMMARY OF BACKGROUND DATA:The reported reinterve...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-199603010-00017
更新日期:1996-03-01 00:00:00
abstract:STUDY DESIGN:A three-dimensional, nonlinear finite element analysis was performed to predict the in situ contact interaction of prosthesis components of the Prodisc-L in a multisegmental lumbar model following total disc replacement (TDR). OBJECTIVE:Efforts were made to investigate how the TDR implant contact characte...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e3181ae23d1
更新日期:2009-09-15 00:00:00
abstract::Between July 1983 and November 1986, 29 patients with thoracolumbar burst fractures underwent a one-stage operation consisting of anterior decompression by subtotal vertebrectomy, reduction, and stabilization with the Slot-Zielke device. The mean follow-up was 3.1 years. Most patients with incomplete neurologic lesion...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-199101000-00013
更新日期:1991-01-01 00:00:00
abstract:STUDY DESIGN:A retrospective analysis of a case series was performed. OBJECTIVE:To describe a novel technique to monitor femoral nerve function by analyzing the saphenous nerve somatosensory evoked potential (SSEP) during transpsoas surgical exposures of the lumbar spine. SUMMARY OF BACKGROUND DATA:During transpsoas ...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0000000000000357
更新日期:2014-07-01 00:00:00
abstract:STUDY DESIGN:Retrospective review. OBJECTIVE:To report the incidence of and risk factors for intraoperative cardiopulmonary arrest (ICA) in children undergoing spinal deformity surgery. SUMMARY OF BACKGROUND DATA:Spinal deformities in children are associated with comorbidities that can pose substantial risks during s...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0000000000001105
更新日期:2015-11-01 00:00:00
abstract:STUDY DESIGN:Retrospective clinical study. OBJECTIVE:The aim of this study was to evaluate retrospectively the safety and efficacy of 1-stage surgical treatment of 45 consecutive patients, who had progressive congenital spinal deformity associated with split spinal cord malformation (SSCM). SUMMARY OF BACKGROUND DATA...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e3182608988
更新日期:2012-12-01 00:00:00
abstract:STUDY DESIGN:In vivo validation during functional loading. OBJECTIVE:To determine the accuracy and repeatability of a model-based tracking technique that combines subject-specific computed tomographic (CT) models and high-speed biplane x-ray images to measure three-dimensional (3D) in vivo cervical spine motion. SUMM...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e31820b7e2f
更新日期:2011-03-15 00:00:00
abstract:STUDY DESIGN:Posture and motion analysis after a Cotrel-Dubousset instrumentation. OBJECTIVES:To investigate the compensation role of pelvis. SUMMARY OF BACKGROUND DATA:Few existing studies found no compensation at the lower unfused level but did not investigate the pelvis. METHODS:Thirty patients were analyzed befo...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/01.brs.0000219402.01636.87
更新日期:2006-05-20 00:00:00
abstract:STUDY DESIGN:A case of primary Ewing sarcoma of the lumbar spine is presented. OBJECTIVE:To present and review a rare case of primary Ewing sarcoma of the lumbar spine that required differentiation from spinal infection. SUMMARY OF BACKGROUND DATA:Primary Ewing sarcoma originating from the spinal column is very rare....
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e3181995ec2
更新日期:2009-04-20 00:00:00
abstract:STUDY DESIGN:A retrospective analysis. OBJECTIVE:This study aimed to compare the safety and efficacy between the fusion-nonfusion hybrid construct (HC: anterior cervical corpectomy and fusion plus artificial disc replacement, ACCF plus cADR) and anterior cervical hybrid decompression and fusion (ACHDF: anterior cervic...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0000000000000588
更新日期:2014-11-01 00:00:00
abstract:STUDY DESIGN:Case report of a solitary osteochondroma of the cervical spine causing myelopathy in a 66-year-old woman. OBJECTIVES:To review the relevant literature and describe a highly unusual clinical manifestation of solitary osteochondroma. SUMMARY OF BACKGROUND DATA:Osteochondromas are common benign bony lesions...
journal_title:Spine
pub_type: 杂志文章,评审
doi:10.1097/00007632-200005150-00017
更新日期:2000-05-15 00:00:00
abstract:STUDY DESIGN:Human lumbar functional spinal units (FSUs) were moved throughout their range of motion in sagittal and lateral bending while the dynamics of this movement were computed in vitro. Functional spinal units were tested intact and after subsequent discectomy and unilateral facetectomy. OBJECTIVE:To establish ...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-199712150-00007
更新日期:1997-12-15 00:00:00
abstract:STUDY DESIGN:Retrospective study. OBJECTIVE:To evaluate the outcomes and safety of endoscopic laminectomy for central lumbar canal spinal stenosis. SUMMARY OF BACKGROUND DATA:.: Spinal endoscopy is mostly used in the treatment of lumbar disc herniation, while endoscopic laminectomy for lumbar spinal stenosis is rarel...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0000000000003478
更新日期:2020-07-15 00:00:00
abstract::A new screening test and operative technique for the relief of intractable pain in the failed back syndrome has been devised and has yielded a 72% success rate on short-term follow-up (9--30 months) in 26 patients. This syndrome is thought to represent pain emanating from permanently damaged nerve roots and not from t...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-198007000-00011
更新日期:1980-07-01 00:00:00
abstract:STUDY DESIGN:Coil springs were stretched and attached to produce a compressive force across the lumbar intervertebral discs of dogs for up to 53 weeks. OBJECTIVE:To test the hypothesis that compressive forces applied to the intervertebral disc for a long period of time cause disc degeneration in vivo in a dog model. ...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/00007632-200012010-00006
更新日期:2000-12-01 00:00:00
abstract:STUDY DESIGN:Retrospective review. OBJECTIVE:To define the geographic variation in costs of anterior cervical discectomy and fusion (ACDF) and posterolateral fusion (PLF). SUMMARY OF BACKGROUND DATA:ACDF and lumbar PLF are common procedures that are used in the treatment of spinal pathologies. To optimize value, both...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0000000000001022
更新日期:2015-09-01 00:00:00
abstract:STUDY DESIGN:Retrospective review and prospective validation study. OBJECTIVE:To develop a classification system of lumbar lateral listhesis that suggests different likelihoods of having radiculopathy in adult scoliosis. SUMMARY OF BACKGROUND DATA:The association of lumbar lateral listhesis with radiculopathy remains...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0000000000002986
更新日期:2019-07-15 00:00:00
abstract:STUDY DESIGN:In vivo animal study. OBJECTIVES:To describe a new porcine disc degeneration model, and to analyze disc remodeling and degeneration after nucleotomy with special view to the different nucleus pulposus (NP) cell types. SUMMARY OF BACKGROUND DATA:Thus far, predominantly smaller animals were used for disc d...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e3181b723c9
更新日期:2009-12-01 00:00:00
abstract:STUDY DESIGN:Scoliosis patients were prospectively x-rayed in three positions with independent analysis. OBJECTIVES:To determine if one positioning technique provides superior visualization of critical landmarks (C7, T2, T12, L5-S1) and to determine any position dependent variations in regional measures or sagittal ba...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/01.brs.0000153698.94091.f8
更新日期:2005-02-15 00:00:00
abstract:STUDY DESIGN:Case report. OBJECTIVE:To report the first case of posterior spinal artery (PSA) infarct due to patent foramen ovale (PFO). SUMMARY OF BACKGROUND DATA:Infarct in the territories of PSA are very rare: till now 38 cases are reported in the literature. Moreover only 1 case of spinal cord infarction was attr...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e3181cf29ea
更新日期:2010-03-01 00:00:00
abstract:STUDY DESIGN:The authors prospectively evaluated 40 patients with paralytic scoliosis treated from 1985 to 1990 with bilateral posterior segmental instrumentation, facet fusions, local bone graft, and allograft (mostly fresh frozen) bone supplementation only. OBJECTIVES:The authors report the fusion results for these ...
journal_title:Spine
pub_type: 杂志文章
doi:
更新日期:1994-12-01 00:00:00
abstract:STUDY DESIGN:We first present 2 cases of spinal arteriovenous fistulae (AVFs) successfully treated with the help of intra-arterial indocyanine green (ICG) angiography. OBJECTIVE:To demonstrate the efficacy of intra-arterial ICG angiography in spinal AVFs compared with the role of intravenous ICG injection and intraope...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e31822ba834
更新日期:2012-02-15 00:00:00
abstract:STUDY DESIGN:Literature review of basic scientific and clinical research in spinal cord injury (SCI). OBJECTIVE:To provide physicians with an overview of the neurobiologic challenges of SCI, the current status of investigation for novel therapies that have been translated to human clinical trials, and the preclinical,...
journal_title:Spine
pub_type: 杂志文章,评审
doi:10.1097/BRS.0b013e3181f3286d
更新日期:2010-10-01 00:00:00
abstract:STUDY DESIGN:Single-center prospective non-randomized matched cohort comparison. OBJECTIVE:To compare elective lumbar spine surgery outcomes for cases triaged through a multidisciplinary spine pathway versus conventional referral processes. SUMMARY OF BACKGROUND DATA:Many health care systems have facilitated low back...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0000000000003785
更新日期:2020-11-04 00:00:00
abstract:STUDY DESIGN:Analysis of positional magnetic resonance images of normal volunteers. OBJECTIVE:To compare the reliability and precision of an active shape model to that of conventional lordosis measurements. SUMMARY OF BACKGROUND DATA:Characterization of lumbar lordosis commonly relies on measurement of angles; these ...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0b013e31816949e6
更新日期:2008-04-01 00:00:00
abstract:STUDY DESIGN:A randomized, controlled clinical trial. OBJECTIVE:This randomized controlled clinical trial was aimed at comparing the clinical outcomes of combined posteroanterior (P-A) fusion and transforaminal thoracic interbody fusion (TTIF) in cases of thoracolumbar fracture-dislocation. SUMMARY OF BACKGROUND DATA...
journal_title:Spine
pub_type: 杂志文章,随机对照试验
doi:10.1097/BRS.0000000000000529
更新日期:2014-10-01 00:00:00
abstract:STUDY DESIGN:Randomized laboratory cadaver study. OBJECTIVE:The objective of this study was to determine the accuracy of anterior transpedicular screw placement in the cervical spine using conventional fluoroscopy versus computer-assisted navigation. SUMMARY OF BACKGROUND DATA:Traditionally, global cervical instabili...
journal_title:Spine
pub_type: 杂志文章
doi:10.1097/BRS.0000000000000786
更新日期:2015-04-01 00:00:00