Supra-psoas shallow docking in lateral interbody fusion.
BACKGROUND
Lateral interbody fusion techniques have been linked with considerable postoperative morbidity, often the outcome of direct psoas trauma. The most common neurological postoperative complications are transient motor weakness/palsy and sensory dysesthesia, which can be permanent. It appears that these neural complications are a result of passing through the psoas muscle where the potential for nerve injury is significant. The supra-psoas shallow docking method may be a safer alternative and may help minimize morbidities by eliminating or reducing direct psoas injury.


OBJECTIVE
To describe the operative technique of performing lateral interbody fusion using supra-psoas retractor docking.


METHODS
The authors describe the surgical technique including side selection, positioning, and patient outcomes.


RESULTS
Fifteen patients were treated with the supra-psoas shallow docking method. Specifically, no patient reported weakness, numbness, and/or pain on the side that underwent the surgery. In these cases, performing lateral transpsoas interbody fusion using supra-psoas shallow docking appeared to minimize the most common neurological postoperative complications of the surgery, motor weakness/palsy and sensory dysesthesia, which may be a result of dilation of the psoas muscle.


CONCLUSIONS
The shallow docking technique may decrease postoperative morbidities by docking on top of psoas muscle instead of passing through it. An important potential benefit of this approach is direct visualization of the lumbosacral plexus, which may potentially minimize the postoperative neurological morbidity often encountered in patients after this surgery.
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. Frank.acosta@cshs.org
Frank L
FL
Acosta
Doniel
D
Drazin
John C
JC
Liu
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control; D016658:Psoas Muscles / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*