Skip to main content
SpringerLink
Log in

Anatomical positional changes in the lateral lumbar interbody fusion

  • Supplement article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Introduction

ALIFs and LLIFs are now becoming more utilized for adult spinal disease. As technologies advance, so do surgical techniques, with surgeons now modifying traditional supine-ALIF and lateral-LLIF to lateral-ALIF and prone-LLIF approaches to allow for more efficient surgeries. The objective of this study is to characterize the anatomical changes in the surgical corridor that occur with changes in patient positioning.

Methods

MRIs of ten healthy volunteers were evaluated in five positions: supine, prone with hips flexed, prone with hips extended, lateral with hips flexed, and lateral with hips extended. All lateral scans were in the left lateral decubitus position. The anatomical changes of the psoas muscles, inferior vena cava, aorta, iliac vessels were assessed with relation to fixed landmarks on the disc spaces from L1 to S1.

Results

The most anteriorly elongated ipsilateral to approach psoas when compared to supine was seen in lateral-flexed position (− 5.82 mm, p < 0.001), followed by lateral-extended (− 2.23 mm, p < 0.001), then prone-flexed (− 1.40 mm, p = 0.014), and finally supine and prone-extended (− 0.21 mm, p = 0.643). The most laterally extending or “thickest” psoas was seen in prone-flexed (− 1.40 mm, p = 0.004) and prone-extended (− 1.17 mm, p = 0.002). The psoas was “thinnest” in lateral-extended (2.03 mm, p < 0.001) followed by lateral-flexed (1.11 mm, p = 0.239). The contralateral psoas did not move as anteriorly as the ipsilateral. 3D volumetric analysis showed that the greatest changes in the psoas occur at its proximal and distal poles near T12-L1 and L4-S1. In lateral-flexed compared to prone-extended, the IVC moves medially to the left (p < 0.001). The aorta moves laterally to the left (p = 0.005). The venous structures appeared more full and open in the lateral positions and flattened in the supine and prone positions. The arteries remain in full calibre.

Conclusion

The MRI anatomical evaluation shows that the psoas, and therefore lumbar plexus, and vasculature move significantly with changes in positioning. This is important for preoperative planning for proper intraoperative execution from preoperative supine MRI. Understanding that the psoas and vessels move the most anteriorly in the lateral-flexed position and to a least degree in the prone-extended is essential for safe and efficient utilization of techniques such as the traditional LLIF, traditional ALIF, prone-LLIF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. 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. https://doi.org/10.3171/2008.10.Spi08479

    Article  PubMed  Google Scholar 

  2. Hu WK, He SS, Zhang SC et al (2011) An MRI study of psoas major and abdominal large vessels with respect to the X/DLIF approach. Eur Spine J 20:557–562. https://doi.org/10.1007/s00586-010-1609-1

    Article  PubMed  Google Scholar 

  3. Ozgur BM, Aryan HE, Pimenta L, Taylor WR (2006) Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:435–443. https://doi.org/10.1016/j.spinee.2005.08.012

    Article  PubMed  Google Scholar 

  4. Salzmann SN, Shue J, Hughes AP (2017) Lateral lumbar interbody fusion-outcomes and complications. Curr Rev Musculoskelet Med 10:539–546. https://doi.org/10.1007/s12178-017-9444-1

    Article  PubMed  PubMed Central  Google Scholar 

  5. Uribe JS, Arredondo N, Dakwar E, Vale FL (2010) Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study. J Neurosurg Spine 13:260–266. https://doi.org/10.3171/2010.3.SPINE09766

    Article  PubMed  Google Scholar 

  6. Ziino C, Konopka JA, Ajiboye RM, et al (2018) Single position versus lateral-then-prone positioning for lateral interbody fusion and pedicle screw fixation. J Spine Surg 4:717–724. https://doi.org/10.21037/jss.2018.12.03

  7. Blizzard DJ, Thomas JA (2018) MIS Single-position Lateral and Oblique Lateral Lumbar Interbody Fusion and Bilateral Pedicle Screw Fixation: Feasibility and Perioperative Results. Spine (Phila Pa 1976) 43:440–446. https://doi.org/10.1097/BRS.0000000000002330

  8. Buckland AJ, Ashayeri K, Leon C et al (2020) Single position circumferential fusion improves operative efficiency, reduces complications and length of stay compared with traditional circumferential fusion. Spine Journal. https://doi.org/10.1016/j.spinee.2020.11.002

    Article  Google Scholar 

  9. Moro T, Kikuchi S, ichi, Konno S ichi, Yaginuma H, (2003) An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. Spine 28:423–427. https://doi.org/10.1097/01.BRS.0000049226.87064.3B

    Article  PubMed  Google Scholar 

  10. Banagan K, Gelb D, Poelstra K, Ludwig S (2011) Anatomic mapping of lumbar nerve roots during a direct lateral transpsoas approach to the spine: a cadaveric study. Spine (Phila Pa 1976) 36:E687–91. https://doi.org/10.1097/BRS.0b013e3181ec5911

  11. Regev GJ, Chen L, Dhawan M, et al (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. https://doi.org/10.1097/BRS.0b013e3181a029e1

  12. Benglis DM, Elhammady MS, Levi AD, Vanni S (2008) minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity. Neurosurgery 63:A191–A196. https://doi.org/10.1227/01.NEU.0000325487.49020.91

    Article  Google Scholar 

  13. Kepler CK, Bogner EA, Herzog RJ, Huang RC (2011) 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. https://doi.org/10.1007/s00586-010-1593-5

    Article  PubMed  Google Scholar 

  14. Lamartina C, Berjano P (2020) Prone single-position extreme lateral interbody fusion (Pro-XLIF): preliminary results. Eur Spine J 29:6–13. https://doi.org/10.1007/s00586-020-06303-z

    Article  PubMed  Google Scholar 

  15. Quillo-Olvera J, Lin GX, Jo HJ, Kim JS (2018) Complications on minimally invasive oblique lumbar interbody fusion at L2-L5 levels: a review of the literature and surgical strategies. Ann Transl Med; 6:101. https://doi.org/10.21037/atm.2018.01.22

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Texas Back Institute, 6020 W. Parker Road, Suite 200, Plano, TX, 75093, USA

    Shashank V. Gandhi

  2. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA

    Robert Dugan, Samuel H. Farber, Jakub Godzik, Lea Alhilali & Juan S. Uribe

Authors
  1. Shashank V. Gandhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert Dugan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samuel H. Farber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jakub Godzik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lea Alhilali
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Juan S. Uribe
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SVG—study design, data collection, data analysis, manuscript preparation. RD—data collection, manuscript preparation. SHF—study design, manuscript preparation. JG—study design. LA—study design, data collection, data analysis. JSU—study design, manuscript preparation.

Corresponding author

Correspondence to Shashank V. Gandhi.

Ethics declarations

Conflict of interests:

Juan Uribe, MD receives royalties and consultation fees from Nuvasive and consultation fees from SI Bone.

Ethics approval

IRB compliant, ethics committee compliant.

Consent to participate

All subjects provided informed consented to participate.

Availability of data and material:

All data and deidentified MRIs are available.

Consent for publication

All authors and subjects consented to publication.

Code availability:

3D Slicer was used for volumetric analysis. Program available at https://www.slicer.org.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gandhi, S.V., Dugan, R., Farber, S.H. et al. Anatomical positional changes in the lateral lumbar interbody fusion. Eur Spine J 31, 2220–2226 (2022). https://doi.org/10.1007/s00586-022-07195-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-022-07195-x

Keywords

Search

Navigation