Applied anatomy and imaging study on genitofemoral nerve with respect to the XLIF approach
Chinese Journal of Clinical Anatomy ›› 2015, Vol. 33 ›› Issue (6) : 617-622.
Applied anatomy and imaging study on genitofemoral nerve with respect to the XLIF approach
Objective To investigate the position of genitofemoral nerve (GFN) in each vertebral space by dissection, then measure and calculate the data on lumbar magnetic resonance image to investigate GFN’s traveling position in the lumbar intervertebral space. Combined with the position of the great vessels and lumbar spinal nerve roots, the secure zone of each vertebral space in extreme lateral interbody fusion(XLIF) was located. Methods 16 cases of adult cadavers were dissected, GFN’s position in the psoas major muscle and out the psoas major muscle was observed. The position of psoas major muscle and abdominal great vessels in 36 cases of lumbar magnetic resonance image was measured, the secure zone of XLIF approach in each vertebral space was analyzedand calculated. Results GFN was parabolic or nearly straight forward in the psoas major muscle, its position was above the line from its origin point in foramen to the point where it pierced out of the psoas major muscle. In samples that GFN pierce out of the psoas muscle at intervertebral space L3/4 or above, the distance from the posterior edge to GFN was (34.0±6.02)mm, and GFN was located in Zone A and I by Moro’s method. In samples that GFN exited the psoas muscle below intervertebral space L3/4, the distance from the posterior edge to GFN was not less than (16.0±2.16)mm, and GFN might be located in Zone I、II and III. Conclusion The security zone of XLIF approach at intervertebral space L2/3 is zone II and III, at intervertebral space L4/5 is Zone II. When GFN exitspsoas major muscle at intervertebral space L3/4 or above, the secure zone of XLIF approach at intervertebral space L3/4 is zone II. When GFN exits the psoas muscle below intervertebral space L3/4, approach from any zone at intervertebral space L3/4 has a chance to damage the blood vessels or nerve.
[1] White AAI, Panjabi MM. Clinical biomechanics of the spine[M]. 2nd edition. Philadelphia:Lippincott Williams & Wilkins; 1990.
[2] Ozgur BM, Aryan HE, Pimenta L, et al. Extreme lateral interbody fusion ( XLIF) : a novel surgical technique for anterior lumbar interbody fusion[J]. Spine J, 2006, 6(4): 435-443.
[3] Rodgers WB, Cox CS, Gerber EJ. Early complications of extreme lateral interbody fusion in the obese[J]. J Spinal Disord Tech, 2010, 23(6): 393-397.
[4] Rodgers WB, Gerber EJ, Patterson J. Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases[J]. Spine, 2010, 36(1): 26-32.
[5] Tohmeh AG, Rodgers WB, Peterson MD. Dynamically evoked, discrete -threshold electromyography in the extreme lateral interbody fusion approach[J]. J Neurosurg Spine, 2011, 14(1): 31-37.
[6] 廖丙修. XLIF入路相关的生殖股神经应用解剖及影像解剖研究[D]. 广州：广州医科大学, 2015:26-27.
[7] Moro T, Kikuchi S, Konno S, et al. An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery[J]. Spine, 2003, 28(5):423-428.
[8] Jahangiri FR, Sherman JH, Holmberg A, et al. Protecting the genitofemoral nerve during direct/extreme lateral interbodyfusion(DLIF/XLIF) procedures[J].Am J ElectroneurodiagnosticTechnol, 2010, 50(4): 321-335.
[9] Uribe JS, ValeFL, Dakwar E. Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery[J].Spine, 2010, 35(26 Suppl):S368-374.
[10] Woodall MN, Shakir B, Smitherman A, at al. Technical note:Resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion[J]. Int J Spine Surg, 2013, 7:39-41.
[11] Bendersky M, Sola C, MuntadasJ, et al. Monitoring lumbar plexus integrity in extreme lateral transpsoas approaches to the lumbar spine: a new protocol with anatomical bases[J]. Eur Spine J, 2015, 24(5):1051-1057.
[12] 刘金伟, 丁自海, 汪坤菊, 等. 生殖股神经腰大肌内段的应用解剖[J]. 解剖学杂志, 2009, 32(1): 91-102.
[13] 陆声, 徐永清, 丁自海, 等. 生殖股神经的解剖及临床意义[J].颈腰痛杂志, 2008, 29(3):206-208.
[14] Benglis DM, Vanni S, Levi AD. An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine [J]. J Neurosurg Spine, 2009, 10(2):139-144.
[15] Kepler CK. Bogner EA. Herzog RJ. et al. Anatomy of the psoas muscle and lumbar plexus with respect to the surgical approach for lateral transpsoas interbody fusion[J].Eur Spine J, 2011, 20(4):550-556.
/
| 〈 |
|
〉 |
