Lateral Lumbar Interbody Fusion at L4-5: A Morphometric Analysis of Psoas Anatomy and Cage Placement.

Background: The ventral elevation (VE) of the psoas from the vertebral column as seen on axial magnetic resonance imaging has been suggested as a preclusion of a safe working zone for lateral lumbar interbody fusion (LLIF) at L4-5. However, no quantitative study has been conducted to verify this.

Methods: L4-5 LLIF was attempted using 22-mm wider cages whenever feasible over 18-mm standard cages in a consecutive series of 62 patients.

Custom-Made Titanium 3-Dimensional Printed Interbody Cages for Treatment of Osteoporotic Fracture-Related Spinal Deformity.

Background: Advances in minimally invasive interbody fusion have greatly enhanced surgeons' capability to correct adult spinal deformity with reduced morbidity. However, the feasibility of such approaches is limited in patients with previous osteoporotic fractures as the resultant vertebral deformity renders the end plate geometry incongruous with conventional interbody implants. Current 3-dimensional (3D) printing technology offers a novel solution by fabricating custom-made implants tailored to individual anatomy.

Lateral lumbar interbody fusion at the lumbosacral junction.

Due to the obstruction of the iliac crest and the retroperitoneal vessels, lateral lumbar interbody fusion (LLIF) is generally considered contraindicated at the lumbosacral junction (LSJ). In particular the 'rise' of the psoas from the vertebral column in the lower lumbar segments has been associated with significant overlap of the lumbar plexus with the vertebral body and exclusion of a safe transpsoas entry. However in selected individuals anatomical variations may help circumvent the difficulties and the anatomical corridor posterior to the lumbar plexus may provide an alternative to the conventional anterior approach.

A radiographic analysis of cage positioning in lateral transpsoas lumbar interbody fusion.

Direct Lumbar Interbody Fusion (DLIF) and eXtreme Lateral Interbody Fusion (XLIF) are the most common surgical platforms available for performing transpsoas spinal fusion but no study has been carried out to compare them. We evaluated 21 DLIF and 22 XLIF cage positions by measuring the distance between the posterior vertebral border and the centre of the cage normalised to the midsagittal length of the inferior end plate. We found that DLIF cages were significantly more anteriorly located than XLIF (0.

Direct Tubular Lumbar Microdiscectomy for Far Lateral Disc Herniation: A Modified Approach.

Objective: The concept of minimally invasive tubular discectomy is based on precise placement of the retractor over the surgical target to minimize collateral tissue trauma. For far lateral disc herniation, the junction between the pars and the transverse process has generally been adopted as the target for facilitating early nerve root exposure; however, this may limit access to the disc space and increase the risks of iatrogenic neuralgia. An alternative approach to help address these issues involving docking the retractor caudally directly over the disc space with the aid of a microscope is here proposed.

Microscopic tubular discectomy for far lateral lumbar disc herniation.

Microscopic tubular discectomy (MTD) reduces muscle trauma associated with treatment of far lateral lumbar disc herniation (FLDH), but data from randomised controlled studies concerning its efficacy on posterolateral disc herniation, has failed to demonstrate its superiority over standard open techniques. Importantly concerns have been raised that it may be inferior in terms of relief of leg and back pain. Although several FLDH series show that MTD can deliver excellent outcomes, the volume of literature in this field has remained small and evidence based on health-related quality of life (HRQOL) measures, scarce.