Bhavuk Garg1, Nishank Mehta2, Vivek Vijayakumar1, Anupam Gupta1. 1. Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India. 2. Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India. mehta.nishank@gmail.com.
Abstract
PURPOSE: To present a radiographic analysis of the anatomy of the lumbar plexus and retroperitoneal blood vessels with respect to psoas morphology and safe working zones (SWZ) for LLIF. METHODS: A retrospective radiographic analysis of 158 MRI scans was performed. Selected morphometric measurements were performed at L1-L2, L2-L3, L3-L4 and L4-L5 levels: disc anteroposterior distance, psoas anteroposterior distance, lumbar plexus-anterior disc distance, lumbar plexus-anterior psoas distance, vena cava-anterior disc distance and calculation of SWZ in psoas on both left and right sides. The morphometric measurements were analysed for differences with sex and the level. RESULTS: All the morphometric parameters differed significantly at all levels between males and females. The SWZ was significantly wider on the left side compared to the right-at L2-L3, L3-L4 and L4-L5 levels in females and at L3-L4 and L4-L5 levels in males. The SWZ at L4-L5 was narrowest on both left and right sides-and significantly reduced compared to other levels. 6.9% patients had a SWZ > 20 mm on the left side, and 44.9% patients had SWZ < 20 mm on the right side. With caudal progression of levels, the lumbar plexus and psoas muscle migrated anteriorly and the vena cava/right iliac vein migrated posteriorly. CONCLUSION: A detailed study of preoperative MRI scans should be carried out in patients planned for LLIF-particularly, at L4-L5 level and in females. A left-sided trans-psoas approach is safer to perform compared to the right side-a right-sided approach should be avoided at L4-L5 considering the narrow SWZ at that level.
PURPOSE: To present a radiographic analysis of the anatomy of the lumbar plexus and retroperitoneal blood vessels with respect to psoas morphology and safe working zones (SWZ) for LLIF. METHODS: A retrospective radiographic analysis of 158 MRI scans was performed. Selected morphometric measurements were performed at L1-L2, L2-L3, L3-L4 and L4-L5 levels: disc anteroposterior distance, psoas anteroposterior distance, lumbar plexus-anterior disc distance, lumbar plexus-anterior psoas distance, vena cava-anterior disc distance and calculation of SWZ in psoas on both left and right sides. The morphometric measurements were analysed for differences with sex and the level. RESULTS: All the morphometric parameters differed significantly at all levels between males and females. The SWZ was significantly wider on the left side compared to the right-at L2-L3, L3-L4 and L4-L5 levels in females and at L3-L4 and L4-L5 levels in males. The SWZ at L4-L5 was narrowest on both left and right sides-and significantly reduced compared to other levels. 6.9% patients had a SWZ > 20 mm on the left side, and 44.9% patients had SWZ < 20 mm on the right side. With caudal progression of levels, the lumbar plexus and psoas muscle migrated anteriorly and the vena cava/right iliac vein migrated posteriorly. CONCLUSION: A detailed study of preoperative MRI scans should be carried out in patients planned for LLIF-particularly, at L4-L5 level and in females. A left-sided trans-psoas approach is safer to perform compared to the right side-a right-sided approach should be avoided at L4-L5 considering the narrow SWZ at that level.
Authors: Matthias Pumberger; Alexander P Hughes; Russel R Huang; Andrew A Sama; Frank P Cammisa; Federico P Girardi Journal: Eur Spine J Date: 2011-12-01 Impact factor: 3.134
Authors: Aaron J Buckland; Bryan M Beaubrun; Evan Isaacs; John Moon; Peter Zhou; Sam Horn; Gregory Poorman; Jared C Tishelman; Louis M Day; Thomas J Errico; Peter G Passias; Themistocles Protopsaltis Journal: Asian Spine J Date: 2018-02-07
Authors: Anna Kot; Jarosław Polak; Tomasz Klepinowski; Maciej J Frączek; Roger M Krzyżewski; Anna Grochowska; Tadeusz J Popiela; Borys M Kwinta Journal: Surg Radiol Anat Date: 2021-12-07 Impact factor: 1.246