Abstract
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 <20 mm, 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.
Similar content being viewed by others
References
Benglis DM, Vanni S, Levi AD (2009) An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine. J Neurosurg Spine 10:139–144
Farny J, Drolet P, Girard M (1994) Anatomy of the posterior approach to the lumbar plexus block. Can J Anaesth 41:480–485
Kirchmair L, Lirk P, Colvin J, Mitterschiffthaler G, Moriggl B (2008) Lumbar plexus and psoas major muscle: not always as expected. Reg Anesth Pain Med 33:109–114
Laban MM (2006) Atrophy and clinical weakness of the iliopsoas muscle: a manifestation of hip osteoarthritis. Am J Phys Med Rehabil 85:629
Moro T, Kikuchi S, Konno S, Yaginuma H (2003) An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. Spine 28:423–428 (discussion 427–428)
Rasch A, Bystrom AH, Dalen N, Berg HE (2007) Reduced muscle radiological density, cross-sectional area, and strength of major hip and knee muscles in 22 patients with hip osteoarthritis. Acta Orthop 78:505–510
Regev GJ, Chen L, Dhawan M, Lee YP, Garfin SR, Kim CW (2009) 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) 34:1330–1335
Sevinc O, Barut C, Is M, Eryoruk N, Safak AA (2008) Influence of age and sex on lumbar vertebral morphometry determined using sagittal magnetic resonance imaging. Ann Anat 190:277–283
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kepler, C.K., Bogner, E.A., Herzog, R.J. et al. Anatomy of the psoas muscle and lumbar plexus with respect to the surgical approach for lateral transpsoas interbody fusion. Eur Spine J 20, 550–556 (2011). https://doi.org/10.1007/s00586-010-1593-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-010-1593-5