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Figure9.An anatomic cross-section below midlevel of the left kidney. The anatomic cross-section shows the termination of the posterior renal fascia in relationship to the fascia of the quadratus lumborum muscle (arrow). A clear view and identification of these fasciae could not be observed at the posterior pararenal space because this relationship is variable and the medial extent of the posterior pararenal space varies from patient to patient. K=kidney; PM=psoas muscle; C=descending colon; ARF=anterior renal fascia; LCF=lateroconal fascia; PRF=posterior renal fascia; 1=anterior pararenal space; 2=perirenal space; 3=posterior pararenal space. Meyers MA, Charnsangavej C, Oliphant M. Meyers' dynamic radiology of the abdomen: normal and pathologic anatomy. New York: Springer; 2011. xviii, 419 p. 124; with permission.
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Lateral approach spine surgery provides effective interbody stabilization, and correction and indirect neural decompression with minimal-incision and less invasive surgery compared with conventional open anterior lumbar fusion. It may also avoid the trauma to paraspinal muscles or facet joints found with transforaminal lumbar interbody fusion and p...
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Abstract Background Unilateral laminectomy for bilateral decompression (ULBD) for lumbar spinal stenosis (LSS) is a less invasive technique compared to conventional laminectomy. Recently, several authors have reported favorable results of low back pain (LBP) in patients of LSS treated with ULBD. However, the detailed changes and localization of LBP...
Citations
... The lateral transpsoas technique consists of accessing the spine by placing a retractor through a retroperitoneal corridor. 7 When the retractor is opened, retroperitoneal fat can creep into the surgical field and can obstruct the surgeon's view of the disc space. Continuing the procedure may result in an increased risk of a surgical complication, and attempting to remove the adipose tissue risks injuring the peritoneum. ...
Lateral lumbar interbody fusion (LLIF) is a popular technique as it allows for the placement of a large interbody implant through a retroperitoneal, transpsoas working corridor. Historically, the interbody is placed with the patient in lateral decubitus and then repositioned to prone for the posterior instrumentation. While this has been an effective and successful technique, removing the interoperative flip would improve the efficiency of these cases. This has led to modified LLIF approaches including single-position prone LLIF (pLLIF). This modification has shown to be an efficient and powerful technique; however, learning to navigate the LLIF approach in the prone position has its own challenges. The purpose of this article is to provide a detailed description of our pLLIF technique while simultaneously introducing surgical tips to overcome the challenges of the approach and optimize the implantation of the interbody device.
... However, there have been no reports of CLAP from the anterior or lateral side for the approaching vertebral bodies, intervertebral discs, or iliopsoas muscle. For retroperitoneal CLAP, it is necessary to place the tube close to the site of infection to increase the local antimicrobial concentration because the retroperitoneal space is large [23]. In addition, there is a possibility that the tube may deviate from its intended position. ...
... In the present case, the placement of the tube in the scar or the iliopsoas muscle prevented tube deviation. The contrast agent injected through the dual-lumen tubes had a contrast effect within the iliopsoas muscle and intervertebral space, confirming that the antibiotics were correctly delivered to the infected site even when placed in the retroperitoneal space, which is sparser and more complex than posterior structures [23]. Moreover, we avoided complications due to the spread of Gentamycin over a large space, which did not occur. ...
Pyogenic vertebral osteomyelitis (PVO) is a prevalent infection in the elderly, frequently complicated by iliopsoas and epidural abscesses. Traditional treatments are often ineffective for refractory cases. In this report, a 76-year-old man with PVO, iliopsoas, and epidural abscess was unresponsive to antibiotics, presenting with severe lower back pain and functional impairments. A two-stage surgical intervention was implemented: anterior debridement, autogenous bone graft fixation, and novel application of retroperitoneal continuous local antibiotic perfusion (CLAP), followed by posterior fixation. A contrast test verified correct CLAP perfusion into the iliopsoas abscess and intervertebral disc space. Substantial improvements were noted postoperatively, including a marked reduction in pain, inflammation, and the size of both abscesses. In conclusion, this case demonstrates the feasibility and effectiveness of retroperitoneal CLAP in treating refractory PVO, offering a potential innovative solution for cases resistant to conventional therapies.
... However, there have been no reports of CLAP from the anterior or lateral side for the approaching vertebral bodies, intervertebral discs, or iliopsoas muscle. For retroperitoneal CLAP, it is necessary to place the tube close to the site of infection to increase the local antimicrobial concentration because the retroperitoneal space is large [23]. In addition, there is a possibility that the tube may deviate from its intended position. ...
... In the present case, the placement of the tube in the scar or the iliopsoas muscle prevented tube deviation. The contrast agent injected through the dual-lumen tubes had a contrast effect within the iliopsoas muscle and intervertebral space, confirming that the antibiotics were correctly delivered to the infected site even when placed in the retroperitoneal space, which is sparser and more complex than posterior structures [23]. Moreover, we avoided complications due to the spread of Gentamycin over a large space, which did not occur. ...
... e APS contains the ascending and descending colon, the duodenum, and the pancreas. [35] Both pararenal spaces communicate behind the duodenum and pancreas. e pelvis is connected through the potential space between the parietal peritoneum anteriorly and the anterior renal fascia posteriorly along the path of the ureter. ...
... It is mainly composed of fat. [2,35] Hemorrhage may be encountered in patients with bleeding disorders by the femoral vessels on anticoagulation or catheterization procedures [22,38] [ Figures 9 and 10]. Neoplasms may also be encountered in this space. ...
The retroperitoneum, a complex anatomical space within the abdominopelvic region, encompasses various vital abdominal organs. It is compartmentalized by fascial planes and contains potential spaces critical in multiple disease processes, including inflammatory effusions, hematomas, and neoplastic conditions. A comprehensive understanding of the retroperitoneum and its potential spaces is essential for radiologists in identifying and accurately describing the extent of abdominopelvic disease. This pictorial review aims to describe the anatomy of the retroperitoneum while discussing commonly encountered pathologies within this region. Through a collection of illustrative images, this review will provide radiologists with valuable insights into the retroperitoneum, facilitating their diagnostic proficiency to aid in appropriate patient clinical management.
... Термин «OLIF» был впервые описан в 2012 г. в работе Silvestre et al. [23]. Детальное описание анатомического доступа с возможностью безопасного проведения операции на уровнях с L 1 до S 1 позвонков было подтверждено в различных исследованиях [18,[26][27][28]. ...
Objective. To perform comparative analysis of the clinical efficacy and safety of indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach (OLIF) with anterolateral (OLIF-AF) and posterior percutaneous (OLIF-PF) screw fixations in the surgical treatment of single-segment lumbar stenosis.
Material and Methods. A retrospective comparative analysis of treatment of 88 patients aged 29 to 72 years with single-level lumbar stenosis was carried out. Posterior instrumental fixation (OLIF-PF) was performed in 60 cases, and anterolateral (OLIF-AF) – in 28.
Results. The compared groups did not statistically significantly differ from each other in terms of age, gender, body mass index, clinical picture and duration of symptoms before surgery, assessment of neurological status according to the Zurich Claudication Questionnaire (ZCQ), preoperative diagnosis, localization of stenosis, pain assessment in the back and leg before surgery according to a digital rating scale, physical status (ASA), health assessment (SF-12, ODI), follow-up period, as well as smoking and the presence of comorbidities (p > 0.05). In the OLIF-AF group, compared to the OLIF-PF group, a statistically significant advantage was found in terms of blood loss, duration of surgery and anesthesia, the level of radiological exposure, duration of patient’s hospitalization and hospital stay in the postoperative period, as well as the duration of antibiotic prophylaxis and intraoperative volume of infusions (p < 0.05). Despite earlier discharge and less use of local anesthesia (35.7 % vs 73.3 %; p = 0.001), patients in the OLIF-AF group had statistically significantly lower level of back pain on the day of discharge (3.0 vs 3.5; p = 0.034) and were less likely to need opioids (3.6 % vs 31.7 %; p = 0.003). With regard to complications and adverse events, there were no statistically significant differences during dynamic follow-up period from 3 to 50 months in both groups (17.9 % vs 28.3 %; p = 0.290), including depending on the timing of complications (early or late). In addition, no statistically significant differences were found for neurological, infectious, gastrointestinal, urological, or implant-related complications (p > 0.05).
Conclusions. Indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach in combination with OLIF-AF is an effective and safe technique for the surgical treatment of single-segment lumbar stenosis. This method allows to reduce the invasiveness of surgery and severity of the pain syndrome and to create conditions for enhanced recovery after surgery. Further multicenter randomized trials are needed to comprehensively evaluate long-term outcomes.
... 14,24 La disección progresiva de los planos de la pared abdominal, empleando la disección roma y visualizando directamente las estructuras anatómicas, evita la lesión de los nervios subcostal, ilioinguinal, iliohipogástrico y femorocutáneo lateral. 25 Una vez se accede al retroperitoneo, se recomienda continuar la disección roma realizando movimientos en sentido posteroanterior y caudalcraneal hasta localizar adecuadamente el espacio vertebral que se encuentra delante del músculo psoas. 23 El espacio anterior al músculo psoas puede ser ampliado con una leve retracción o disección posterior del vientre anterior de dicho músculo. ...
Introducción. La fusión intersomática lumbar oblicua (OLIF) es una alternativa mínimamente invasiva a la fusión intersomática por vía posterior que permite preservar los elementos vertebrales posteriores, aumentar la altura discal con descompresión indirecta de elementos neurales e insertar cajas de fusión intercorporal más grandes. Objetivo. Describir los resultados clínicos del uso de la OLIF para el tratamiento de la enfermedad degenerativa del disco en un hospital universitario de España. Material y métodos. Estudio de serie de casos retrospectivo realizado en 32 pacientes con enfermedad degenerativa de la columna lumbar que fueron tratados mediante OLIF entre enero de 2018 y junio de 2020. Mediante la revisión de historias clínicas, se recolectaron datos sociodemográficos y clínicos. Los resultados clínicos se evaluaron antes de la cirugía y en un seguimiento al año usando el índice de discapacidad de Oswestry (ODI) y la escala analógica visual (EVA) para el dolor lumbar y radicular, respectivamente. Resultados. Se implantaron 42 cajas intersomáticas y la edad promedio fue 56,25 años. Los niveles vertebrales intervenidos con mayor frecuencia fueron L4-L5 (50%) y L3-L4 (28,57%). El promedio de tiempo quirúrgico y estancia hospitalaria fue de 153,13 minutos y 2,53 días, respectivamente. Se evidenció mejoría estadísticamente significativa en el ODI (p<0,001) y los puntajes EVA del dolor de lumbar (p=0,002) y radicular (p<0.001) antes de la cirugía y al año. Conclusión. La OLIF representa una opción de tratamiento quirúrgico seguro y eficaz para tratar la enfermedad degenerativa de la columna lumbar.
... Para intentar minimizar este tipo de complicaciones es recomendable revisar adecuadamente las imágenes preoperatorias para valorar el espacio prepsoático y la anatomía vertebral y vascular 11,23 . La disección progresiva de los planos de la pared abdominal, empleando la disección roma y visualizando directamente las estructuras anatómicas, evita la lesión de los nervios subcostal, ilioinguinal, iliohipogástrico y fémoro-cutáneo lateral 24 . Una vez alcanzado el espacio retroperitoneal es recomendable continuar con disección roma realizando movimientos en sentido postero-anterior y caudal-craneal hasta localizar adecuadamente el espacio vertebral por delante del psoas 22 . ...
Introducción: la fusión intersomática lumbar oblicua (OLIF) es una alternativa mínimamente invasiva a la fusión intersomática abierta tradicional. Permite al cirujano acceder al espacio discal mediante un abordaje retroperitoneal anterior al músculo psoas. Tiene la ventaja teórica de preservar los ligamentos longitudinales, aumentar la altura del disco con descompresión indirecta de los elementos neurales e inserción de cajas de mayor tamaño. Objetivo: el propósito de este estudio fue evaluar los resultados clínicos de una serie consecutiva de 32 pacientes sometidos a fusión intersomática lumbar oblicua por enfermedad degenerativa de la columna lumbar. Material y métodos: Treinta y dos pacientes con hallazgos radiológicos de enfermedad degenerativa de la columna lumbar fueron tratados mediante OLIF entre enero de 2017 y junio de 2019. Los resultados clínicos se evaluaron mediante el índice de discapacidad de Oswestry (ODI), la escala analógica visual (EVA) para el dolor de espalda y EVA para el dolor de extremidades inferiores, antes de la cirugía y en el primer año de seguimiento. Además, se revisaron retrospectivamente los siguientes parámetros: edad, sexo, tipo de enfermedad degenerativa, número de niveles de fusión, tiempo operatorio, duración de la estancia hospitalaria y complicaciones quirúrgicas. Resultados: Se implantaron 42 cajas intersomáticas en 32 pacientes. El 56,25% de los pacientes eran mujeres, con una edad media de 56 (30-79) años. El número de niveles fusionados fue 1 en 21 pacientes (65,6%), 2 en 7 pacientes (21,9%) y 3 en 4 pacientes (12,5%). El nivel de fusión fue L1-L2 en 2 pacientes (4,76%), L2-L3 en 7 pacientes (16,67%), L3-L4 en 12 pacientes (28,57%) y L4-L5 en 21 pacientes (50%). El tiempo operatorio medio fue de 153,13 (88-210) minutos y el tiempo medio de estancia hospitalaria fue de 2,53 días (1-5). El análisis estadístico mostró significancia para los resultados en ODI, EVA para el dolor de espalda y EVA para el dolor de extremidades inferiores. 4 pacientes presentaron paresia transitoria del psoas por tracción del músculo. Tres pacientes presentaban entumecimiento transitorio de la ingle y el muslo y un paciente tuvo una lesión del plexo simpático. Conclusión: la fusión intersomática lumbar oblicua ofrece a los pacientes una opción de tratamiento quirúrgico seguro y eficaz para tratar la enfermedad degenerativa de la columna lumbar.
... 6 Disorders of the RPS, described as "hinterland of straggling mesenchyme with vascular and nervous plexuses, weird embryonic rests, and shadowy fascial boundaries," 3 are challenging since symptoms are nonspecific, and this compartment encompasses a variety of entities. 1,3 In-depth knowledge of normal anatomy and mechanism of disease is critically important for patient evaluation. 1 In all presented cases, history and physical examination remained the cornerstone of diagnosis. ...
... Surgical treatment is usually recommended for patients in whom conservative treatment fails as it results in better clinical outcomes (3). In contrast, traditional open surgery requires extensive dissection of the paravertebral muscles, resulting in muscle ischemia, denervation, and atrophy, leaving patients with residual back pain (4,5). Various minimally invasive techniques have been developed in recent years to overcome these shortcomings. ...
The incidence of lumbar spinal stenosis is increasing annually, and with an ever-aging population and longer life expectancies, this trend will further continue. It is hoped that a more effective treatment can be found so that the patients can be relieved of their pain. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of unilateral biportal endoscopic surgery (UBE) and microscopic decompression surgery (MD) for the treatment of lumbar spinal stenosis. A literature search of related studies published until April 2022 was performed using PubMed, EMBASE, Cochrane Library, Web of Science, ClinicalTrials.gov, Google Scholar, China National Knowledge Infrastructure (CNKI), and other databases. After filtering of references, 12 eligible studies were identified that compared UBE with MD as a treatment for lumbar spinal stenosis. Data were extracted and analysed using R. A total of 12 articles (four randomized controlled and eight cohort studies) were included, with a total of 1,067 patients: 250 men and 249 women in the UBE group and 290 men and 278 women in the MD group. The meta-analysis showed that the mean intraoperative blood loss in the UBE group [standardized mean difference (SMD)=-2.10, 95% confidence interval (CI) (-3.97, -0.23), P=0.03] was lower than that in the MD group. The postoperative Visual analogue scale (VAS) score for back pain [SMD=-0.52, 95% CI (-0.76, -0.27), P<0.01], leg pain [SMD=-0.30, 95% CI (-0.51, -0.08), P<0.01], postoperative Oswestry disability index [(ODI); SMD=-0.25, 95% CI (-0.48, -0.03), P=0.03], and postoperative C-reactive protein [(CRP); odds ratio (OR)=-0.92, 95% CI (-1.80, 0.03), P=0.04] were lower than those in the MD group. Complications (OR=0.60, 95% CI (0.37, 0.98), P=0.04) and hospital stay (SMD=-1.84, 95% CI (-2.85, 0.83), P <0.01] were also lesser in the UBE group than in the MD group. UBE was preferable to that in the MD group according to the modified MacNab score [OR=2.28, 95% CI (1.28, 4.06), P<0.01]. No significant differences were observed in the operation times between the groups. UBE surgery was found to be a better option for the treatment of lumbar spinal stenosis than MD surgery.
... The surgical approach for an oblique lateral interbody fusion (OLIF) requires navigating through an anatomical area termed the safe corridor (SC). The SC is located bilaterally between the anteromedial aspect of the psoas major and the posterolateral aspect of the aorta, inferior vena cava (IVC), or common iliac vessels, depending on side and disk level [1][2][3]. Despite the natural approach access offered by the SC, there are several approach-related risks including injury to nervous, urologic, visceral, and vascular structures [4][5][6][7][8]. ...
Purpose
The primary aim was to measure the safe corridor (SC), surgical incision anterior margin (AM), and posterior margin (PM) for OLIF bilaterally from L1 to L5. The secondary aim was to determine the feasibility of approach via the SC. The tertiary aim was to analyze the influence of demographic and anthropometric factors on OLIF parameters.
Methods
We performed a radiographic analysis of 100 subjects who received an abdominal CT. Measurements of the AM, PM, and SC were obtained as well as patient age, sex, height, weight, and BMI. The intraclass correlation coefficient was used to evaluate interrater reliability. To assess associations among variables, Pearson’s correlation tests and multivariate linear regression models were constructed. Sex differences were analyzed using Student’s t tests.
Results
At L1-2, L2-3, L3-4, and L4-5, the PM was 6.6, 8.2, 9.4, and 10.2 cm on the left side and 7.2, 7.7, 8.8, and 9.5 cm on the right side in relation to the disk space center. The SC was less than 1 cm 1%, 3%,3%, and 18% of the time on the left side, and 15%, 12%,29%, and 60% on the right side. None of the anthropometric factors demonstrated a strong correlation with incision location. SC was larger on the left side. Interrater ICC was .934.
Conclusions
This study is the first to provide guidelines on the appropriate location of the incision line during OLIF based on SC from L1 to L5. SC measurements do not vary by sex. OLIF is more feasible via a left-sided approach.
