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Updated: Dec 6, 2025
Three-dimensional Navigation-guided, Prone, Single-position, Lateral Lumbar Interbody Fusion Technique
Published on: July 15, 2021
Defining a safe working zone for lateral lumbar interbody fusion: a radiographic, cross-sectional study
Bhavuk Garg1, Nishank Mehta2, Vivek Vijayakumar1
1Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
Purpose:
To present a radiographic analysis of the anatomy of the lumbar plexus and retroperitoneal blood vessels with respect to psoas morphology and safe working zones (SWZ) for LLIF.
Methods:
A retrospective radiographic analysis of 158 MRI scans was performed. Selected morphometric measurements were performed at L1-L2, L2-L3, L3-L4 and L4-L5 levels: disc anteroposterior distance, psoas anteroposterior distance, lumbar plexus-anterior disc distance, lumbar plexus-anterior psoas distance, vena cava-anterior disc distance and calculation of SWZ in psoas on both left and right sides. The morphometric measurements were analysed for differences with sex and the level.
Results:
All the morphometric parameters differed significantly at all levels between males and females. The SWZ was significantly wider on the left side compared to the right-at L2-L3, L3-L4 and L4-L5 levels in females and at L3-L4 and L4-L5 levels in males. The SWZ at L4-L5 was narrowest on both left and right sides-and significantly reduced compared to other levels. 6.9% patients had a SWZ > 20 mm on the left side, and 44.9% patients had SWZ < 20 mm on the right side. With caudal progression of levels, the lumbar plexus and psoas muscle migrated anteriorly and the vena cava/right iliac vein migrated posteriorly.
Conclusion:
A detailed study of preoperative MRI scans should be carried out in patients planned for LLIF-particularly, at L4-L5 level and in females. A left-sided trans-psoas approach is safer to perform compared to the right side-a right-sided approach should be avoided at L4-L5 considering the narrow SWZ at that level.
