J Korean Neurosurg Soc.  2018 Nov;61(6):707-715. 10.3340/jkns.2017.0296.

Does the Access Angle Change the Risk of Approach-Related Complications in Minimally Invasive Lateral Lumbar Interbody Fusion? An MRI Study

• Huang C
• Xu Z
• Li F
• Chen Q

• KMID: 2428112
• DOI: http://doi.org/10.3340/jkns.2017.0296

Abstract

OBJECTIVE
To investigate the potential risk of approach-related complications at different access angles in minimally invasive lateral lumbar interbody fusion.
METHODS
Eighty-six axial magnetic resonance images were obtained to analyze the risk of approach-related complications. The access corridor were simulated at different access angles and the potential risk of neurovascular structure injury was evaluated when the access corridor touching or overlapping the corresponding structures at each angle. Furthermore, the safe corridor length was measured when the corridor width was 18 and 22 mm.
RESULTS
When access angle was 0°, the potential risk of ipsilateral nerve roots injury was 54.7% at L4-L5. When access angle was 45°, the potential risk of abdominal aorta, contralateral nerve roots or central canal injury at L4-L5 was 79.1%, 74.4%, and 30.2%, respectively. The length of the 18 mm-wide access corridor was largest at 0° and it could reach 44.5 mm at L3-L4 and 46.4 mm at L4-L5. While the length of the 22 mm-wide access corridor was 42.3 mm at L3-L4 and 44.1 mm at L4-L5 at 0°.
CONCLUSION
Changes in the access angle would not only affect the ipsilateral neurovascular structures, but also might adversely influence the contralateral neural elements. It should be also noted to surgeons that alteration of the access angle changed the corridor length.

Keyword

Minimally invasive lateral lumbar interbody fusion; Access angle; Access corridor; Approach-related complications; Magnetic resonance images

MeSH Terms

Aorta, Abdominal
Magnetic Resonance Imaging*
Surgeons

Figure

• 

  Fig. 1. The potential risk of the neurovascular structures injury at different access angles at L3–L4 level. A : The long dimension of the green rectangle with 18mm width was parallel to SCPL. The green dotted lines indicated the left extension lines of the green rectangle. The blue rectangle along with the blue dotted lines came from the green rectangle rotating around the disc center with angle α. The potential risk of neurovascular injury was recorded at the angle α of 0°, 5°, 15°, 30° and 45° if the rectangle and the space between extension line touched or overlapped these structures. B : The area between anterior edge of the disc and the SCPL was divided into four zones. The long dimension of the green rectangle was parallel to SCLP. The blue rectangle came from the green rectangle rotating around the disc center with angle α and the length of it was adjusted to avoid exceeding the border of the disc. The blue dotted line was the axis of the blue rectangle and it intersected the disc border (AB) at the access point (C). The distribution of the access point at each zone and the relative position between access axis and the genitofemoral nerve were analyzed. AA : abdominal aorta, GN : genitofemoral nerve, SCPL : sagittal central perpendicular line, O : disc center, NR : nerve roots, CC : central canal.

• 

  Fig. 2. Measurements of the corridor length at different access angles and widths. ABCD came from the rectangle rotating around the disc center with an angle α, long dimension of which was parallel to SCPL. A´B´C´D´ indicated the rectangle with the width extending from 18mm to 22 mm. The length of the rectangle with 18 mm width (AB) and 22 mm width (A´B´) was measured at the angle α of 0°, 5°, 15°, 30°, and 45°. SCPL : sagittal central perpendicular line, O : disc center.

• 

  Fig. 3. The position of the access axis relative to genitofemoral nerve and potential risk of genitofemoral nerve injury at different access angles. (A) and (B) indicated the measurements of relevant parameters at L3–L4 and L4–L5, respectively. The blue, red or green color indicated the access axis was anterior, median or posterior to genitofemoral nerve, respectively. The location of these colors indicated access points at each zone. *The comparison for the potential risk of genitofemoral nerve injury between L3–L4 and L4–L5 at all access angles using Fisher exact test. † The genitofemoral nerve injury was determined by the rectangle and the space between extension line touching or overlapping it at different access angles according to Fig. 1A. GN : genitofemoral nerve, N/A : not available.

Reference

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