MRI-based Planning for an Extreme Lateral Interbody Fusion Procedure. Is It Safe? An MRI Study Describing the Statistical Distribution of Safe and Danger Zones
Abstract
Objective: The objective of this study is to provide an anatomical description of the structures involved in the extreme lateral interbody fusion (XLIF) technique based on MRI images in the dorsal decubitus position. Materials and Methods: An observational, descriptive, and retrospective study of 200 patients treated at our institution was conducted using MRI images of the lumbosacral spine. The vena cava, aorta artery, and the width and height of the psoas muscle were measured in axial images to establish the safe and danger zones. Results: The final sample consisted of 164 patients, with a mean age of 50.4 for males and 50.6 for females.The abdominal aorta artery is located predominantly on the left side zone A on its path to the L3-L4 space. When it reaches the L4-L5 area, the iliac arteries bifurcate in 95.7% of the patients. The vena cava tends to be located on the right side, bifurcating at the L4-L5 level. Conclusions: Preoperative planning and safe zone delimitation are simple methods for determining the relative position of neural and vascular anatomical structures in relation to the surgical area. This technique can help spine surgeons prevent perioperative complications.Downloads
References
Soriano-Sánchez JA, Baabor-Aqueveque M, Silva-Morales F. Philosophy and concepts of modern spine surgery.
Acta Neurochir Suppl 2011;108:23-31. https://doi.org/10.1007/978-3-211-99370-5_5
Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme lateral interbody fusion (XLIF): a novel surgical technique
for anterior lumbar interbody fusion. Spine J 2006;6(4):435-43. https://doi.org/10.1016/j.spinee.2005.08.012
Tubbs RI, Gabel B, Jeyamohan S, Moisi M, Chapman JR, Hanscom RD, et al. Relationship of the lumbar plexus
branches to the lumbar spine: anatomical study with application to lateral approaches. Spine J 2017;17(7):1012-6.
https://doi.org/10.1016/j.spinee.2017.03.011
Mandelli C, Colombo EV, Sicuri GM, Mortini P. Lumbar plexus nervous distortion in XLIF® approach: an
anatomic study. Eur Spine J 2016;25(12):4155-63. https://doi.org/10.1007/s00586-016-4617-y
Dakwar E, Vale FL, Uribe JS. Trajectory of the main sensory and motor branches of the lumbar plexus outside the psoas muscle related to the lateral retroperitoneal transpsoas approach. J Neurosurg Spine 2011;14(2):290-5.
https://doi.org/10.3171/2010.10.SPINE10395
Park DK, Lee MJ, Lin EL, Singh K, An HS, Phillips FM. The relationship of intrapsoas nerves during a transpsoas
approach to the lumbar spine: anatomic study. J Spinal Disord Tech 2010;23(4):223-8. https://doi.org/10.1097/BSD.0b013e3181a9d540
Banagan K, Gelb D, Poelstra K, Ludwig S. Anatomic mapping of lumbar nerve roots during a direct lateral
transpsoas approach to the spine: a cadaveric study. Spine (Phila PA 1976) 2011;36(11):E687-E691.
https://doi.org/10.1097/BRS.0b013e3181ec5911
Davis TT, Bae HW, Mok JM, Rasouli A, Delamarter RB. Lumbar plexus anatomy within the psoas muscle:
implications for the transpsoas lateral approach to the L4-L5 disc. J Bone Joint Surg Am 2011;93(16):1482-7.
https://doi.org/10.2106/JBJS.J.00962
Guerin P, Obeid I, Bourghli A, Masquefa T, Luc S, Gille O, et al. The lumbosacral plexus: anatomic considerations for minimally invasive retroperitoneal transpsoas approach. Surg Radiol Anat 2012;34(2):151-7.
https://doi.org/10.1007/s00276-011-0881-z
He L, Kang Z, Tang WJ, Rong LM. A MRI study of lumbar plexus with respect to the lateral transpsoas approach to the lumbar spine. Eur Spine J 2015;24(11):2538-45. https://doi.org/10.1007/s00586-015-3847-8
Walker CT, Farber SH, Cole TS, Xu DS, Godzik J, Whiting AC, et al. Complications for minimally invasive lateral
interbody arthrodesis: a systematic review and meta-analysis comparing prepsoas and transpsoas approaches. J
Neurosurg Spine 2019;30(4):417-550. https://doi.org/10.3171/2018.9.SPINE18800
Hu WK, He SS, Zhang SC, Liu YB, Li M, Hou TS, et al. An MRI study of psoas major and abdominal large vessels
with respect to the X/DLIF approach. Eur Spine J 2011;20(4):557-62. https://doi.org/10.1007/s00586-010-1609-1
Gary MF, Wang MY. Approaching a deformity from the concavity versus convexity. En: Wang M, Sama A, Uribe J (eds). Lateral access minimally invasive spine surgery. Berlin: Springer Verlag; 2016:297-304.
Lu S, Xu YQ, Ding ZH, Wang YL, Shi JH, Zhong SZ. Clinical anatomic study of the lower lumbar anterolateral
vein: with respect to retroperitoneal endoscopic surgery. Chin J Traumatol 2008;11(2):110-3.
https://doi.org/10.1016/s1008-1275(08)60023-1
Hamid M, Toussaint PJ, Delmas V, Gillot C, Coutaux A, Plaisant O. Anatomical and radiological evidence for the
iliolumbar vein as an inferior lumbar venous system. Clin Anat 2007;20(5):545-52. https://doi.org/10.1002/ca.20489
Marchi L, Pimenta L, Oliveira L, Fortti F, Amaral R, Abdala N. Distance between great vessels and the lumbar
spine: MRI study for anterior longitudinal ligament release through a lateral approach. J Neurol Surg A Cent Eur
Neurosurg 2017;78(2):144-53. https://doi.org/10.1055/s-0036-1592144
Moro T, Kikuchi S, Konno S, Yaginuma H. An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. Spine (Phila Pa 1976) 2003;28(5):423-8 (discussion 427-8). https://doi.org/10.1097/01.BRS.0000049226.87064.3B
Voyadzis JM, Felbaum D, Rhee J. The rising psoas sign: an analysis of preoperative imaging characteristics of
aborted minimally invasive lateral interbody fusions at L4-5. J Neurosurg Spine 2014;20(5):531-7.
https://doi.org/10.3171/2014.1.SPINE13153
Buckland AJ, Vira S, Oren JH, Lafage R, Harris BY, Spiegel MA, et al. When is compensation for lumbar spinal
stenosis a clinical sagittal plane deformity? Spine J 2016;16:971-81. https://doi.org/10.1016/j.spinee.2016.03.047
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
