Neural anatomy, neuromonitoring and related complications in extreme lateral interbody fusion: video lecture

Abstract

The lateral retroperitoneal transpsoas approach to the lumbar spine requires passage in close proximity to both superficial and deep neural structures [1, 2]. While the majority of nerves that are at risk for injury in the lateral approach are located on and within psoas major (e.g., femoral and genitofemoral nerves), the subcostal, lateral femoral cutaneous, ilioinguinal, and iliohypogastric nerves are all located outside of the psoas muscle and may be encountered prior to passage through the psoas muscle (superficial nerves). Given the less-invasive nature of the approach adjacent to these structures, a clear understanding of the relevant anatomy with respect to neural architecture, followed by close adherence to intraoperative neuromonitoring and surgical technique may reduce the risk of neurologic injury.