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European Spine Journal

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01-12-2016 | Original Article

Lumbar plexus nervous distortion in XLIF^® approach: an anatomic study

Authors: Carlo Mandelli, Elena Virginia Colombo, Giovanni Marco Sicuri, Pietro Mortini

Published in: European Spine Journal | Issue 12/2016

Abstract

Purpose

XLIF^® is a widely used minimally invasive technique to treat different spine pathologies. The aim of this study was to quantify nerve distortion of lumbar plexus during XLIF^® approach and to correlate it with morphometric data.

Methods

Nine fresh frozen cadaveric specimens were used. All specimens were subjected to the same dissection procedure cored on a left XLIF® approach at L2/L3 and L4/L5 levels. Distortion of cutaneous superficial nerves, femoral nerve (FN) at L4/L5 and genitofemoral nerve (GN) at L2/L3 and L4/L5 while opening the retractor were assessed and analyzed with respect to psoas muscle features.

Results

Superficial nerves were slightly displaced but never stretched. FN, as well as GN at L4/L5 level, could be displaced and stretched by the blades. Statistically significant correlation between FN distortion and the amount of psoas fibers interposed between the posterior blade of the retractor and the nerve itself (TCK) was found. GN distortion was found to be related to its clock position on an axial section of psoas muscle seen from cranially at L4/L5.

Conclusion

FN was in close connection with the deep psoas muscle fibers and it is subjected to anterior translation that correlates with TCK. This mechanism may partly explain the rate of femoral nerve palsy that occurs despite neuromonitoring and safe entry zones respect. The GN location at L4/L5 should be considered not only for its projection in Zone I, but also for its clock position on the psoas muscle surface, since it affects its distortion.

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Title: Lumbar plexus nervous distortion in XLIF® approach: an anatomic study
Authors: Carlo Mandelli
Elena Virginia Colombo
Giovanni Marco Sicuri
Pietro Mortini
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 12/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-016-4617-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Lumbar plexus nervous distortion in XLIF^® approach: an anatomic study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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