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Lateral Lumbar Interbody Fusion

  • Gabriel Tender
  • Daniel Serban
  • Niki Calina
  • Mihaela Florea
  • Lindsay Lasseigne
Chapter

Abstract

Minimally invasive lateral retroperitoneal transpsoas approach for lumbar interbody fusion is the fastest growing type of minimally invasive spinal fusion in the United States. We prefer to perform the psoas dissection under direct visualization, in order to protect sensory nerves not detected by neuromonitoring, and insert the widest cage possible, typically 22 mm. We use either lateral plating or posterior percutaneous instrumentation to increase stability and maximize fusion rates.

Supplementary material

Video 7.1

L4–5 LLIF. The psoas muscle is fibrous and difficult to dissect. The femoral nerve is exposed during the procedure (an uncommon occurrence) and therefore the retractor has to be repositioned. Angled instruments are used to access the disc in this patient with a high iliac crest (MP4 77880 kb)

Video 7.2

L4–5 LLIF. A far lateral disc herniation is removed via this approach, prior to re-docking and performing the fusion (MP4 30032 kb)

Video 7.3

L4–5 LLIF. The femoral nerve is exposed in the middle of the disc and cannot be mobilized posteriorly. A rare, behind-the-femoral-nerve LLIF is performed (MP4 37533 kb)

Video 7.4

L4–5 LLIF. The genitofemoral nerve is encountered and protected during the transpsoas approach. The psoas has a normal consistency (MP4 8516 kb)

Video 7.5

L4–5 LLIF. The genitofemoral nerve is encountered and protected during the transpsoas approach. The psoas is soft and easy to dissect (MP4 5352 kb)

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Gabriel Tender
    • 1
  • Daniel Serban
    • 2
  • Niki Calina
    • 2
  • Mihaela Florea
    • 2
  • Lindsay Lasseigne
    • 3
  1. 1.Louisiana State UniversityNew OrleansUSA
  2. 2.Department of Neurosurgery“Bagdasar-Arseni” HospitalBucharestRomania
  3. 3.Department of NeurosurgeryLouisiana State University Health Sciences CenterNew OrleansUSA

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