We have located links that may give you full text access.
Anatomical Modifications during the Lateral Transpsoas Approach to the Lumbar Spine. The Impact of Vertebral Rotation.
International Journal of Spine Surgery 2018 January
Background: We investigated impact of vertebral axial rotation on neurovascular anatomy in adult spinal deformity (ASD) patients and provided recommendations on the approach based on degree of axial rotation. In order to isolate vertebral rotation (VR) impact from the superimposed degenerative cascade observed in adulthood, adolescent idiopathic scoliosis (AIS) patients were analyzed.
Methods: Magnetic resonance imaging (MRI) scans (L1-S1) from 50 right-convex thoracic (left-convex lumbar) AIS patients were analyzed. At each intervertebral level, VR, lumbar plexus depth (LPD), and vascular structure depth (VSD) were evaluated. Paired t test analyses were used to describe anatomic differences between the concave and convex aspect of our patients' curves. Correlation analysis was used to investigate relationships with soft tissue modifications and VR.
Results: Fifty AIS patients (17M, 33F) with mean thoracic Cobb of 50.6° ± 17.0° and mean lumbar Cobb of 41.9° ± 13.0° were included. Mean VR at each level was L1-2 = -6.6°, L2-3 = -7.7°, L3-4 = -6.5°, L4-5 = -4.7°, L5-S1 = -2.6° (negative value denotes clockwise rotation). We found significant differences ( P < .05) between concave-convex (right-left) LPD at each level (L1-2 = 3.7 mm, L2-3 = 5.1 mm, L3-4 = 4.2 mm, L4-5 = 2.2 mm, L5-S1 = 2.2 mm). Vascular structure depth was significantly different at L1-L2 (3.2 mm) and L5-S1 (3 mm). Significant correlation was found between increasing VR and concave-convex LPD difference ( r = 0.68, P < .001).
Conclusions: This study demonstrates that displacement of the lumbar plexus is tied to the magnitude of VR in patients with AIS. When approaching the lumbar spine, this displacement widens the safe surgical corridor on the convex side and narrows the corridor on the concave side.
Level of Evidence: IV.
Clinical Relevance: Preoperative review of MRI scans should occur to assess the patient's safe surgical corridor for lateral lumbar interbody fusion (LLIF). Adult spinal deformity surgeons who approach a degenerated spine in patients with progressive AIS in adulthood must carefully plan for patient positioning, neurovascular anatomy, and realignment objectives prior to the day of surgical intervention.
Methods: Magnetic resonance imaging (MRI) scans (L1-S1) from 50 right-convex thoracic (left-convex lumbar) AIS patients were analyzed. At each intervertebral level, VR, lumbar plexus depth (LPD), and vascular structure depth (VSD) were evaluated. Paired t test analyses were used to describe anatomic differences between the concave and convex aspect of our patients' curves. Correlation analysis was used to investigate relationships with soft tissue modifications and VR.
Results: Fifty AIS patients (17M, 33F) with mean thoracic Cobb of 50.6° ± 17.0° and mean lumbar Cobb of 41.9° ± 13.0° were included. Mean VR at each level was L1-2 = -6.6°, L2-3 = -7.7°, L3-4 = -6.5°, L4-5 = -4.7°, L5-S1 = -2.6° (negative value denotes clockwise rotation). We found significant differences ( P < .05) between concave-convex (right-left) LPD at each level (L1-2 = 3.7 mm, L2-3 = 5.1 mm, L3-4 = 4.2 mm, L4-5 = 2.2 mm, L5-S1 = 2.2 mm). Vascular structure depth was significantly different at L1-L2 (3.2 mm) and L5-S1 (3 mm). Significant correlation was found between increasing VR and concave-convex LPD difference ( r = 0.68, P < .001).
Conclusions: This study demonstrates that displacement of the lumbar plexus is tied to the magnitude of VR in patients with AIS. When approaching the lumbar spine, this displacement widens the safe surgical corridor on the convex side and narrows the corridor on the concave side.
Level of Evidence: IV.
Clinical Relevance: Preoperative review of MRI scans should occur to assess the patient's safe surgical corridor for lateral lumbar interbody fusion (LLIF). Adult spinal deformity surgeons who approach a degenerated spine in patients with progressive AIS in adulthood must carefully plan for patient positioning, neurovascular anatomy, and realignment objectives prior to the day of surgical intervention.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association.Circulation 2024 April 19
Essential thrombocythaemia: A contemporary approach with new drugs on the horizon.British Journal of Haematology 2024 April 9
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app