Intraoperative ultrasound visualization of paravertebral anatomy in the retroperitoneal space during lateral lumbar spine surgery

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OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Article Information

Correspondence Hidetoshi Nojiri: Juntendo University, Tokyo, Japan. hnojiri@juntendo.ac.jp.

INCLUDE WHEN CITING Published online May 17, 2019; DOI: 10.3171/2019.3.SPINE181210.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Ultrasonography image (right) obtained during lateral lumbar spine surgery. With the probe head located on the psoas muscle, the blood vessels under the psoas and on the left (ventral) side of the vertebral body in the transverse plane were visualized and were consistent with findings on axial MRI (left). Figure is available in color online only.

  • View in gallery

    A: B-mode ultrasound image of the vertebral body (VB) and psoas muscle (transverse plane). B: B-mode ultrasound image of VB, intervertebral disc, and psoas muscle (coronal plane). C: B-mode ultrasound images of the colon at the L4–5 level and its anteroinferior movement after detachment (transverse plane). D: B-mode ultrasound images of the kidney at the L3 level and its anteroinferior movement after detachment (transverse plane). Figure is available in color online only.

  • View in gallery

    Doppler-mode ultrasound image (A) of major blood vessels and lumbar artery running around the VB (transverse plane). Doppler-mode ultrasound images of lumbar arteries lateral to the VBs (B) and their branches (C) traversing the intervertebral disc (coronal plane). Figure is available in color online only.

References

  • 1

    Anand NBaron EM: Urological injury as a complication of the transpsoas approach for discectomy and interbody fusion. J Neurosurg Spine 18:18232013

  • 2

    Assina RMajmundar NJHerschman YHeary RF: First report of major vascular injury due to lateral transpsoas approach leading to fatality. J Neurosurg Spine 21:7947982014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Atkinson NSSBryant RVDong YMaaser CKucharzik TMaconi G: How to perform gastrointestinal ultrasound: anatomy and normal findings. World J Gastroenterol 23:693169412017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Balsano MCarlucci SOse MBoriani L: A case report of a rare complication of bowel perforation in extreme lateral interbody fusion. Eur Spine J 24 (Suppl 3):4054082015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Deukmedjian ARLe TVDakwar EMartinez CRUribe JS: Movement of abdominal structures on magnetic resonance imaging during positioning changes related to lateral lumbar spine surgery: a morphometric study: clinical article. J Neurosurg Spine 16:6156232012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Ellebæk SBFristrup CWMortensen MB: Intraoperative ultrasound as a screening modality for the detection of liver metastases during resection of primary colorectal cancer—a systematic review. Ultrasound Int Open 3:E60E682017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Freimanis MGJones AF: Transvaginal ultrasonography. Radiol Clin North Am 30:9559761992

  • 8

    Fujibayashi SKawakami NAsazuma TIto MMizutani JNagashima H: Complications associated with lateral interbody fusion: nationwide survey of 2998 cases during the first 2 years of its use in Japan. Spine (Phila Pa 1976) 42:147814842017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Guarracino FBaldassarri R: Transesophageal echocardiography in the OR and ICU. Minerva Anestesiol 75:5185292009

  • 10

    Kanemura TSatake KNakashima HSegi NOuchida JYamaguchi H: Understanding retroperitoneal anatomy for lateral approach spine surgery. Spine Surg Relat Res 1:1071202017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Ozgur BMAryan HEPimenta LTaylor WR: Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:4354432006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Silvestre CMac-Thiong JMHilmi RRoussouly P: Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lumbar interbody fusion in 179 patients. Asian Spine J 6:89972012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Uribe JSDeukmedjian AR: Visceral, vascular, and wound complications following over 13,000 lateral interbody fusions: a survey study and literature review. Eur Spine J 24 (Suppl 3):3863962015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Vasudeva VSAbd-El-Barr MPompeu YAKarhade AGroff MWLu Y: Use of intraoperative ultrasound during spinal surgery. Global Spine J 7:6486562017

  • 15

    Wagai T: Studies on the foundation and development of diagnostic ultrasound. Proc Jpn Acad Ser B Phys Biol Sci 83:2562652007

  • 16

    Wells PN: Ultrasound imaging. Phys Med Biol 51:R83R982006

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