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
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Published:
Jun 17, 2023
Keywords:
XLIF, big blood vessels, lateral interbody fusion, nuclear magnetic resonance, psoas
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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.
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.
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How to Cite
de Zavalía, M., Pierro, I., Mazzeo, J. J., & Gobbi, E. A. (2023). 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. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(3), 351-361. https://doi.org/10.15417/issn.1852-7434.2023.88.3.1702
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Basic Research
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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
19. 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
Acta Neurochir Suppl 2011;108:23-31. https://doi.org/10.1007/978-3-211-99370-5_5
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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
13. 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.
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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