Nerve Root and Lumbar Plexus Proximity to Different Extraforaminal Lumbar Interbody Fusion Trajectories: A Cadaver Study

Study Design:
Cadaver study.
Objective:
To investigate the safety of the extraforaminal lumbar interbody fusion approach.
Summary of Background Data:
Over the last decade the number of techniques available for lumbar interbody fusion has increased. Recent interest has developed in an extraforaminal approach to the intervertebral disc to reduce the morbidity associated with facetectomy. The safety of this extraforaminal corridor with regards to the exiting nerve root and lumbar plexus has yet to be assessed.
Methods:
With the cadaver prone, the C-arm was positioned over the disc of interest and aligned perpendicular to the superior endplate of the inferior vertebral body, with the superior articular process bisecting the available disc space. Three needles were passed into the disc and labeled medial, middle, and lateral. After needle placement, each nerve root and the lumbar plexus were dissected. The distance of each needle to these structures was measured and discectomy was performed to assess potential graft length from a transforaminal and extraforaminal approach.
Results:
We performed the method on levels L1–L5 bilaterally on 2 cadavers, totaling 16 attempts for each needle position. The average distance to nerve of the medial approach (3.2±1.1 mm) was statistically greater than both the middle (1.1±1.4 mm) and lateral (−0.2±2.9 mm) approaches (P

Source: Journal of Spinal Disorders and Techniques - December 1, 2017 Category: Surgery Tags: Primary Research Source Type: research