Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC.
J Neurosurg Spine. 2014 May;20(5):531-7. doi: 10.3171/2014.1.SPINE13153. Epub 2014 Mar 7.
Minimally invasive lateral interbody fusion for the treatment of degenerative disc disease, spondylolisthesis, or scoliosis is becoming increasingly popular. The approach at L4-5 carries the highest risk of nerve injury given the proximity of the lumbar plexus and femoral nerve. The authors present 3 cases that were aborted during the approach because of pervasive electromyography responses throughout the L4-5 disc space. Preoperative imaging characteristics of psoas muscle anatomy in all 3 cases are analyzed and discussed. In all cases, the psoas muscle on axial views was rising away from the vertebral column as opposed to its typical location lateral to it. Preoperative evaluation of psoas muscle anatomy is important. A rising psoas muscle at L4-5 on axial imaging may complicate a lateral approach.
微创侧方椎间融合术治疗退行性椎间盘疾病、脊椎滑脱或脊柱侧凸越来越受欢迎。由于腰椎丛和股神经的接近，L4-5 水平的入路风险最高。作者报告了 3 例因整个 L4-5 椎间盘空间出现弥漫性肌电图反应而中止的病例。对所有 3 例患者的术前影像学特征进行了分析和讨论。在所有病例中，与典型的侧位相比，L4-5 水平的竖脊肌在轴位视图上是远离脊柱的。术前评估竖脊肌解剖结构很重要。L4-5 水平轴位成像上竖脊肌的上升可能会使侧方入路复杂化。
