Hyun W. Bae, MD and Timothy T. Davis, MD, DABNM
Surgical exposure of the lumbar intervertebral disc space with use of minimally invasive techniques via a transpsoas lateral approach has been developed and advocated. The approach has been reported to be suitable for anterior spinal arthrodesis procedures involving the disc spaces cephalad to L5 – S1. Advocates of the transpsoas lateral approach have described its potential benefits when compared with traditional anterior exposures, including less postoperative pain and reduced manipulation of the aorta and inferior vena cava. A variety of specialized retractor systems utilizing this approach have been developed to allow surgeons access to the disc space in a minimally invasive fashion.
In a recent JBJS study, doctors Hyun W. Bae, MD, Timothy T. Davis, MD, et.al. describe the lumbar plexus anatomy relevant to the transpsoas lateral approach. As procedures utilizing the transpsoas lateral surgical approach are performed with increasing frequency, there has been renewed interest in this anatomy. The authors conclude the risk of traction or compression on the femoral nerve is high at the L4 – L5 disc space and surgeons must have a comprehensive understanding not only of the neural anatomy but also the effect of dilators and retractor blades on the neural structures.
In this JBJS-VJO video supplement to the article, Dr. Hyun Bae demonstrates his minimally invasive surgical technique and Dr. Timothy Davis provides in-depth review of the anatomy and the importance of neural monitoring.
Click on any of the images below for a larger view:
See the Corresponding JBJS Article:
- Timothy T. Davis, MD, Hyun W. Bae, MD, MAJ James M. Mok, MD, MC, USA, Alexandre Rasouli, MD, Rick B. Delamarter, MD
- Lumbar Plexus Anatomy within the Psoas Muscle: Implications for the Transpsoas Lateral Approach to the L4-L5 Disc
Aug 2011; 93 (16) [Article]
- Total Run Time: 27:00 minutes
- Catalog Number: 8029
- VJO Publication Date: June, 2012