Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2013 Sep;22(9):2113-9.
doi: 10.1007/s00586-013-2931-1. Epub 2013 Aug 1.

Mini-open lateral retroperitoneal lumbar spine approach using psoas muscle retraction technique. Technical report and initial results on six patients

Kamran Aghayev  1 , Frank D Vrionis
Affiliations
Case Reports

Mini-open lateral retroperitoneal lumbar spine approach using psoas muscle retraction technique. Technical report and initial results on six patients

Kamran Aghayev et al. Eur Spine J. 2013 Sep.

Abstract

Purpose: The main aim of this paper was to report reproducible method of lumbar spine access via a lateral retroperitoneal route.

Methods: The authors conducted a retrospective analysis of the technical aspects and clinical outcomes of six patients who underwent lateral multilevel retroperitoneal interbody fusion with psoas muscle retraction technique. The main goal was to develop a simple and reproducible technique to avoid injury to the lumbar plexus.

Results: Six patients were operated at 15 levels using psoas muscle retraction technique. All patients reported improvement in back pain and radiculopathy after the surgery. The only procedure-related transient complication was weakness and pain on hip flexion that resolved by the first follow-up visit.

Conclusions: Psoas retraction technique is a reliable technique for lateral access to the lumbar spine and may avoid some of the complications related to traditional minimally invasive transpsoas approach.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Anatomical step-by-step demonstration of the approach. a Postero-lateral abdominal wall with different incision marks for different levels. b Opening of the external oblique muscle. c Opening of the internal oblique muscle. d Opening of the transverse muscle and fascia and exposing retroperitoneal fat. e The dissection between the sympathetic plexus and psoas muscle. Inset The muscle has been retracted posteriorly and plexus anteriorly
Fig. 2
Fig. 2
Preoperative radiographic data of illustrative case. a Midline sagittal T2W. b Axial T2W image through L4–5 level. Note fluid accumulation inside facet joints. c Antero-posterior plain radiograph, demonstrating scoliosis
Fig. 3
Fig. 3
Postoperative plain antero-posterior (a) and lateral (b) plain radiographs. c An axial CT picture demonstrating interbody cage. d An axial CT picture demonstrating a screw placement with PMMA cement around it
Fig. 4
Fig. 4
Schematic representation of pure lateral (left), slightly oblique (middle) and anterior (right) retroperitoneal approaches
Fig. 5
Fig. 5
Schematic comparison of three retroperitoneal routes to lumbar spine with corresponding advantages and disadvantages
See this image and copyright information in PMC

References

    1. Pimenta L. Lateral endoscopic transpsoas retroperitoneal approach for lumbar spine surgery. Minas Gerais: VIII Brazilian Spine Society Meeting. Belo Horizonte; 2001.
    1. Youssef JA, McAfee PC, Patty CA, Raley E, DeBauche S, Shucosky E, Chotikul L. Minimally invasive surgery: lateral approach interbody fusion: results and review. Spine (Phila Pa 1976) 2010;35:S302–S311. doi: 10.1097/BRS.0b013e3182023438. - DOI - PubMed
    1. Guerin P, Obeid I, Bourghli A, Masquefa T, Luc S, Gille O, Pointillart V, Vital JM. The lumbosacral plexus: anatomic considerations for minimally invasive retroperitoneal transpsoas approach. Surg Radiol Anat. 2012;34:151–157. doi: 10.1007/s00276-011-0881-z. - DOI - PubMed
    1. Moro T, Kikuchi S, Konno S, Yaginuma H. An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. Spine (Phila Pa 1976) 2003;28:423–428. - PubMed
    1. Samudrala S, Khoo LT, Rhim SC, Fessler RG. Complications during anterior surgery of the lumbar spine: an anatomically based study and review. Neurosurg Foc. 1999;7:e9. - PubMed

Publication types