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Lumbar plexus safe working zones with lateral lumbar interbody fusion: a systematic review and meta-analysis

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Abstract

Purpose

Significant risk of injury to the lumbar plexus and its departing motor and sensory nerves exists with lateral lumbar interbody fusion (LLIF). Several cadaveric and imaging studies have investigated the lumbar plexus position with respect to the vertebral body anteroposterior plane. To date, no systematic review and meta-analysis of the lumbar plexus safe working zones for LLIF has been performed.

Methods

This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Relevant studies reporting on the position of the lumbar plexus with relation to the vertebral body in the anteroposterior plane were identified from a PubMed database query. Quantitative analysis was performed using Welch’s t test.

Results

Eighteen studies were included, encompassing 1005 subjects and 2472 intervertebral levels. Eleven studies used supine magnetic resonance imaging (MRI) with in vivo subjects. Seven studies used cadavers, five of which performed dissection in the left lateral decubitus position. A significant correlation (p < 0.001) existed between anterior lumbar plexus displacement and evaluation with in vivo MRI at all levels between L1-L5 compared with cadaveric measurement. Supine position was also associated with significant (p < 0.001) anterior shift of the lumbar plexus at all levels between L1-L5.

Conclusions

This is the first comprehensive systematic review and meta-analysis of the lumbar neural components and safe working zones for LLIF. Our analysis suggests that the lumbar plexus is significantly displaced ventrally with the supine compared to lateral decubitus position, and that MRI may overestimate ventral encroachment of lumbar plexus.

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Abbreviations

LLIF:

Lateral lumbar interbody fusion

PPS:

Percutaneous pedicle screws

SCPL:

Sagittal central perpendicular line

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Authors and Affiliations

  1. Department of Neurosurgery, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA, 15212, USA

    Dallas E. Kramer, Cody Woodhouse & Alexander Yu

  2. Department of Neurological Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 855, Chicago, IL, 60612, USA

    Mena G. Kerolus

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Kramer, D.E., Woodhouse, C., Kerolus, M.G. et al. Lumbar plexus safe working zones with lateral lumbar interbody fusion: a systematic review and meta-analysis. Eur Spine J 31, 2527–2535 (2022). https://doi.org/10.1007/s00586-022-07352-2

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  • DOI: https://doi.org/10.1007/s00586-022-07352-2

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