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Toshinori Sakai Natsuo Yasui Akira Dezawa 6 2012 16 6 610 614 10.3171/2012.2.SPINE10914 2012.2.SPINE10914 Movement of abdominal structures on magnetic resonance imaging during positioning changes related to lateral lumbar spine surgery: a morphometric study Armen R. Deukmedjian Tien V. Le Elias Dakwar Carlos R. Martinez Juan S. Uribe 6 2012 16 6 615 623 10.3171/2012.3.SPINE1210 2012.3.SPINE1210 Development of a large-animal model to measure dynamic cerebrospinal fluid pressure during spinal cord injury Claire F. Jones Jae H. T. Lee Brian K. Kwon Peter A. Cripton

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Armen R. Deukmedjian, Tien V. Le, Elias Dakwar, Carlos R. Martinez and Juan S. Uribe

Object

The minimally invasive lateral interbody fusion of the lumbar spine through a retroperitoneal transpsoas approach has become increasingly used. Although preoperative imaging is performed supine, the procedure is performed with the patient in the lateral decubitus position. The authors measured the changes in location of the psoas muscle, aorta, inferior vena cava (IVC), iliac vessels, and kidneys with regard to the fixed lumbar spine when moving from a supine to a lateral decubitus position.

Methods

Unenhanced lumbar MRI scans were performed using a 3T magnet in 10 skeletally mature volunteers in the supine, left lateral decubitus (LLD), and right lateral decubitus (RLD) positions. Positional changes in the aorta, IVC, iliac vessels, and kidneys were then analyzed at all lumbar levels when moving from supine to RLD and supine to LLD. Values are presented as group means.

Results

When the position was changed from supine to RLD, both the aorta and the IVC moved up to 6 mm to the right, with increased movement caudally at L3–4. The aorta was displaced 2 mm anteriorly at L1–2, and the IVC moved 3 mm anteriorly at L1–2 and L2–3 and 1 mm posteriorly at L3–4. The left kidney moved 22 mm anteriorly and 15 mm caudally, while the right kidney moved 9 mm rostrally.

When the position was changed from supine to LLD, the aorta moved 1.5 mm to the left at all levels, with very minimal anterior/posterior displacement. The IVC moved up to 10 mm to the left and 12 mm anteriorly, with increased movement rostrally at L1–2. The left kidney moved 3 mm anteriorly and 1 mm rostrally, while the right kidney moved 20 mm anteriorly and 5 mm caudally.

The bifurcation of the aorta was an average of 18 mm above the L4–5 disc space, while the convergence of the iliac veins to form the IVC was at the level of the disc space. The iliopsoas did not move in any quantifiable direction when the position was changed from supine to lateral; its shape, however, may change to become more flat or rounded. When the position was changed from supine to RLD, the right iliac vein moved posteriorly an average of 1.5 mm behind the anterior vertebral body (VB) line (a horizontal line drawn on an axial image at the anterior VB), while the other vessels stayed predominantly anterior to the disc space. When the position was changed from supine to LLD, the right iliac vein moved to a position 1.4 mm anterior to the anterior VB line. There was negligible movement of the other vessels in this position.

Conclusions

The authors showed that the aorta, IVC, and kidneys moved a significant distance away from the surgical corridor with changes in position. At the L4–5 level, a left-sided approach may be riskier because the right common iliac vein trends posteriorly and into the surgical corridor, whereas in a right-sided approach it trends anteriorly.

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Armen R. Deukmedjian, Tien V. Le, Ali A. Baaj, Elias Dakwar, Donald A. Smith and Juan S. Uribe

structures on magnetic resonance imaging during positioning changes related to lateral lumbar spine surgery: a morphometric study. Clinical article . J Neurosurg Spine 16 : 615 – 623 , 2012 16 Fon GT , Pitt MJ , Thies AC Jr : Thoracic kyphosis: range in normal subjects . AJR Am J Roentgenol 134 : 979 – 983 , 1980 17 Halanski MA , Cassidy JA : Do multilevel ponte osteotomies in thoracic idiopathic scoliosis surgery improve curve correction and restore thoracic kyphosis? . J Spinal Disord Tech [epub ahead of print], 2011 18 Jackson RP

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Jeffery R. Head, George N. Rymarczuk, Kevin D. He and James S. Harrop

changes in the thigh (up to 36%), hip flexion weakness, and distal motor weakness due to disruption of the psoas major, as well as traction on the critical neural structures that course therein. 6 , 7 , 17 , 23 Fortunately, catastrophic injuries such as those to the great vessels and bowel are exceedingly rare. 15 , 20 Renal injuries are exceptionally rare. Reports of renal injury following lateral lumbar spine surgery are limited to a handful of instances of ureter disruption, 1 , 10 , 21 , 22 2 cases of postoperative renal infarction, 1 , 18 1 instance of

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Hidetoshi Nojiri, Kei Miyagawa, Hiroto Yamaguchi, Masato Koike, Yoshiyuki Iwase, Takatoshi Okuda and Kazuo Kaneko

damage to the lumbar arteries, 8 , 13 and while uncommon, such damage can be fatal. 2 Measures for preventing complications include having detailed knowledge of the anatomy, carefully interpreting preoperative imaging findings, and having abundant surgical experience with the anterior approach; however, there is currently no established technique for confirming the pathway and avoiding risks in the limited surgical space. Therefore, in the present study, we inserted a transvaginal ultrasound probe into the retroperitoneal space during lateral lumbar spine surgery to

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Takahashi MD, PhD Yosuke Tomita MD, PhD Manabu Minami MD, PhD 09 2019 24 05 2019 31 3 326 333 10.3171/2019.3.SPINE181388 2019.3.SPINE181388 Intraoperative ultrasound visualization of paravertebral anatomy in the retroperitoneal space during lateral lumbar spine surgery Hidetoshi Nojiri 1, 2 MD, PhD Kei Miyagawa 2 MD Hiroto Yamaguchi 2 MD Masato Koike 2 MD, PhD Yoshiyuki Iwase 2 MD, PhD Takatoshi Okuda 1 MD, PhD Kazuo Kaneko 1 MD, PhD 09 2019 17 05 2019 31 3 334 337 10.3171/2019.3.SPINE181210 2019.3.SPINE181210 Risk factors of instrumentation failure and pseudarthrosis