Download Comparison of two techniques

Comparison of two techniques
Satishchandra gore
India
Posterolateral TF
Posterolateral
Extreme lateral TF
Working area shifted to canal by extreme
lateral access
dimensions
lumbar plexus always located in the posterior
the third of psoas major muscle
anterior view, lumbar nerve, arranged from medial to
lateral, from L5 to L2;
lateral view, lumbar nerve arranged from ventral
to dorsal, from L2 to L5.
Figure 2
Morphometric Analysis of the Ventral Nerve Roots and
Retroperitoneal Vessels With Respect to the Minimally
Invasive Lateral Approach in Normal and Deformed
Spines.
Regev, Gilad; Chen, Lina; Dhawan, Mallika; Lee, Yu;
Garfin, Steven; Kim, Choll; MD, PhD
Spine. 34(12):1330-1335, May 20, 2009.
DOI: 10.1097/BRS.0b013e3181a029e1
Figure 2 . An anatomic illustration of the surgical safe
zone (white area), between the nerve roots and the right
retroperitoneal vessel (vena cava).
2
Needle in disc [IMAGE DR yeung]
Cadaveric photograph with overlay of the vertebral bodies and disc spaces as
related to the psoas muscle. The blue line represents the lumbar contribution
of the lumbosacral plexus that continues distally as the femoral nerve; note its
more ventral location at L4–5.
• Axial MRI image at L3–4 demonstrating measurements
in relationship to the anterior intervertebral plane: a
the anterior edge of the psoas muscle (extending just
anterior to the intervertebral plane in this image), b
the anterior aspect of the lumbar plexus, c the location
of the femoral nerve beginning the L3–4 level, d the
position of the posterior edge of either the inferior
vena cava or right iliac vein depending on level, e the
anteroposterior diameter of the psoas muscle. The
diagram also includes measurement (f), the transverse
distance between the lateral aspect of the
intervertebral disc and the medial aspect of the lumbar
plexus
Rt and Left relations
message
• There can only one best way of reaching
target even though wide range is possible.
• Stay close to transverse process and facet.
• Plane of transverse process is physiological
and anchor in intertransverse plane is good.
• Coming at an angle initially is safe and more
dependable.
• Ventral relations of foramen are important.