Abstract
ObjectiveSince the extreme lateral lumbar interbody fusion procedure was first reported by Ozgur in 2006, a large number of clinical studies have been published. Anatomical studies which explore methods to avoid visceral structures, such as the kidney, with this approach have not been examined in detail. We dissected the retroperitoneal space to analyze how the extreme lateral transpsoas approach to the lumbar spine could damage the kidney and related structures.MethodsEight sides from four fresh Caucasian cadavers were used for this study. The latissimus dorsi muscle and the thoracolumbar fascia were dissected to open the retroperitoneum. The fat tissue was removed. Steel wires were then put into the intervertebral disc spaces. Finally, the closest distance between kidney and wires on each interdiscal space was measured.ResultsThe closest distance from the wire in the interdiscal space on L1/2, L2/3 and L3/4 to the kidney ranged from 13.2 mm to 32.9 mm, 20.0 mm to 27.7 mm, and 20.5 mm to 46.6 mm, respectively. The distance from the kidney to the interdiscal space at L4/5 was too great to be considered applicable to this study.ConclusionsThe results of this study might help surgeons better recognize the proximity of the kidney and avoid injury to it during the extreme lateral transpsoas approach to the lumbar spine.
Highlights
The results of this study might help surgeons better recognize the proximity of the kidney and avoid injury to it during the extreme lateral transpsoas approach to the lumbar spine
The minimally invasive retroperitoneal approach to the lumbar spine was first described by Mayer in 1997 [1,2] followed by McAfee, et al in 1998 [2] and Pimenta
According to Kwon and Kim [9], disadvantages of the lateral transpsoas approach to the lumbar spine include the learning curve associated with new surgical procedures and the orientation of regional retroperitoneal anatomy, which is often unfamiliar to spine surgeons
Summary
The minimally invasive retroperitoneal approach to the lumbar spine was first described by Mayer in 1997 [1,2] followed by McAfee, et al in 1998 [2] and Pimenta According to Kwon and Kim [9], disadvantages of the lateral transpsoas approach to the lumbar spine include the learning curve associated with new surgical procedures and the orientation of regional retroperitoneal anatomy, which is often unfamiliar to spine surgeons. Complications caused by this approach include neurologic deficits, injuries to abdominal organs and the ureters, or blood vessels [10]. Anatomical studies aimed at the position of the kidney in relation to this approach have not been performed
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