[IMAGING STUDY ON LUMBAR PLEXUS BY MINIMALLY INVASIVE LATERAL TRANSPSOAS APPROACH]

Area of Science:

• Neurosurgery
• Spinal Anatomy
• Minimally Invasive Surgery

Context:

• Minimally invasive lateral transpsoas approaches are increasingly used for lumbar spine pathologies.
• Understanding the anatomical relationship between the lumbar plexus and the surgical corridor is crucial for safety.
• Previous studies have not fully elucidated the precise spatial relationship across all relevant lumbar levels.

Purpose:

• To analyze the three-dimensional spatial relationship between the lumbar plexus and the transpsoas surgical corridor.
• To evaluate the safety of the minimally invasive lateral transpsoas approach by mapping lumbar plexus distribution.
• To provide anatomical data for optimizing surgical trajectories and minimizing neurological risks.

Summary:

• Magnetic resonance imaging (MRI) and 3D reconstruction were used to map the lumbar plexus in 71 patients.
• The study determined the distance between the lumbar plexus and the sagittal central perpendicular line (SCPL), representing the transpsoas corridor.
• Lumbar plexus branches were found anterior to the SCPL in a significant percentage of patients, particularly at lower lumbar levels (L4-L5).

Impact:

• The findings reveal a ventral shift of the lumbar plexus, especially the genitofemoral nerve, at the L4-L5 level.
• This anatomical understanding highlights the potential for neural retraction during sequential dilation in transpsoas approaches.
• The study provides critical anatomical insights to enhance the safety and precision of minimally invasive lateral lumbar spine surgery.