Elimination of Lumbar Plexus Injury by Changing the Entry Point and Traction Direction of the Psoas Major Muscle in Transpsoas Lateral Lumbar Spine Surgery

Medicina, 2023 · DOI: https://doi.org/10.3390/medicina59040730 · Published: April 8, 2023

Simple Explanation

This study investigates a modified surgical approach to lumbar spine surgery to reduce nerve damage. The conventional lateral approach can sometimes injure the lumbar plexus, leading to complications. The researchers compared this traditional method with a modified approach at the L4/5 level. The modified approach involves entering and splitting the anterior third of the psoas muscle, differing from the conventional method. This change aims to avoid damaging the lumbar plexus during surgery. The study found that the modified approach significantly reduced the incidence of neurological complications compared to the conventional approach. This suggests the modified technique can help surgeons avoid nerve injury during lateral lumbar spine surgery.

Study Duration

Not specified

Participants

100 patients (50 in each group) with lumbar degenerative disease

Evidence Level

Retrospective comparative study

Key Findings

1
The incidence of neurological complications was significantly higher in the conventional group (Group X) compared to the modified approach group (Group A) (10.0% vs. 0.0%, respectively, p < 0.05).
2
Intraoperative neuromonitoring stimulation value was significantly different between the groups (13.1 ± 5.4 mA in group X vs. 18.5 ± 2.3 mA in group A, p < 0.001), indicating a greater distance from the lumbar plexus in the modified approach.
3
Yellow or red signals during intraoperative nerve monitoring were observed in 20 patients (40.0%) in group X, but these signals were not observed in any patient in group A (p < 0.001).

Research Summary

This retrospective comparative study aimed to investigate and compare neurological complications between the conventional lateral approach and a modiﬁed lateral approach at L4/5 for lumbar interbody fusion. The modified surgical procedure included splitting of the anterior third of the psoas muscle, which was dilated by the retractor on the anterior third of the intervertebral disc. The study concludes that lumbar plexus injury can be avoided by following surgical indication criteria based on the location of the lumbar plexus with respect to the psoas muscle and changing the transpsoas approach to the intervertebral disc.

Practical Implications

Reduced Neurological Complications

The modified surgical approach can significantly reduce the risk of lumbar plexus injury during lateral lumbar interbody fusion at L4/5.

Improved Surgical Technique

Changing the entry point and traction direction of the psoas major muscle provides a safer route to the intervertebral disc.

Refined Patient Selection

Using preoperative MRI to assess the relative position of the psoas muscle helps identify suitable candidates for the lateral approach.

Study Limitations

1
Retrospective study design
2
Small number of subjects
3
The maximum value that could be measured for the stimulus threshold was 20 mA, so it was not possible to accurately measure more than that, and the distance was not accurately measured.

Your Feedback

Was this summary helpful?

Back to Neurology