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


Lumbar surgery via a lateral approach is a minimally invasive and highly useful procedure. However, care must be taken to avoid its potentially fatal complications of intestinal and vascular injuries. The object of this study was to evaluate the usefulness of intraoperative ultrasound in improving the safety of lateral lumbar spine surgery.


A transvaginal ultrasound probe was inserted into the operative field, and the intestinal tract, kidney, psoas muscle, and vertebral body were identified using B-mode ultrasound. The aorta, vena cava, common iliac vessels, and lumbar arteries and their associated branches were identified using the color Doppler mode.


The study cohort comprised 100 patients who underwent lateral lumbar spine surgery, 92 via a left-sided approach. The intestinal tract and kidney lateral to the psoas muscle on the anatomical approach pathway were visualized in 36 and 26 patients, respectively. A detachment maneuver displaced the intestinal tract and kidneys in an anteroinferior direction, enabling confirmation of the absence of organ tissues above the psoas. In all patients, the major vessels anterior to the vertebral bodies and the lumbar arteries and associated branches in the psoas on the approach path were clearly visualized in the Doppler mode, and their orientation, location, and positional relationship with regard to the vertebral bodies, intervertebral discs, and psoas were determined.


When approaching the lateral side of the lumbar spine in the retroperitoneal space, intraoperative ultrasound allows real-time identification of the blood vessels surrounding the lumbar spine, intestinal tract, and kidney in the approach path and improves the safety of surgery without increasing invasiveness.

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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