ArticleSurgical and radiologic anatomy : SRA2012
The lumbosacral plexus: anatomic considerations for minimally invasive retroperitoneal transpsoas approach.
Article in Surgical and radiologic anatomy : SRA, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 3 of them syntheses that pooled it.
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Who cites it
34 citing papers in PubMed, 3 syntheses or guidelines pooled it, 96 citations in OpenAlex.
- OLIF versus ALIF: Which is the better surgical approach for degenerative lumbar disease? A systematic review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2023Pooled it
- Lumbar plexus safe working zones with lateral lumbar interbody fusion: a systematic review and meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2022Pooled it
- MIS lateral spine surgery: a systematic literature review of complications, outcomes, and economics.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2015Pooled it
- A comparative cohort study of surgical approaches for adult spinal deformity at a minimum 2-year follow-up.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Article
- The risk factors for low back pain following oblique lateral interbody fusion: focus on sarcopenia.Journal of orthopaedic surgery and research · 2025Article
- Variations of the extrapsoas course of the lumbar plexus with implications for the lateral transpsoas approach to the lumbar spine: a cadaveric study.Acta neurochirurgica · 2024Article
- Efficacy and Safety of the Extreme Lateral Interbody Fusion (XLIF) Technique in Spine Surgery: Meta-Analysis of 1409 Patients.Journal of clinical medicine · 2024Review
- Vascular injury risk stratification for lateral lumbar interbody fusion (LLIF) at L4-L5: a morphometric study using magnetic resonance imaging.Journal of spine surgery (Hong Kong) · 2023Article
- Lumbar Interbody Fusion and Osteobiologics for Lumbar Fusion.Asian spine journal · 2022Article
- L4/5 accessibility for extreme lateral interbody fusion (XLIF): a radiological study.Journal of orthopaedic surgery and research · 2022Article
- Anterior column reconstruction of the lumbar spine in the lateral decubitus position: anatomical and patient-related considerations for ALIF, anterior-to-psoas, and transpsoas LLIF approaches.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2022Article
- Anterior Thigh Pain Following Minimally Invasive Oblique Lateral Interbody Fusion: Multivariate Analysis from a Prospective Case Series.Clinics in orthopedic surgery · 2022Article
- Sonoanatomy of the ilioinguinal, iliohypogastric, genitofemoral, obturator, and pudendal nerves: a practical guide for US-guided injections.Journal of ultrasonography · 2022Review
- Efficacy and radiographic analysis of oblique lumbar interbody fusion in treating lumbar degenerative spondylolisthesis with sagittal imbalance.Neurosurgical review · 2021Article
- Lumbar interbody fusion: recent advances in surgical techniques and bone healing strategies.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2021Review
- Efficacy and radiographic analysis of oblique lumbar interbody fusion in treating adult spinal deformity.PloS one · 2021Article
- Localization of the Lumbar Plexus in the Psoas Muscle: Considerations for Avoiding Lumbar Plexus Injury during the Transpsoas Approach.Spine surgery and related research · 2021Article
- Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls.Asian spine journal · 2020Article
- Outcomes of direct lateral interbody fusion (DLIF) in an Australian cohort.Journal of spine surgery (Hong Kong) · 2019Article
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe minimally invasive transpsoas approach can be employed to treat various spinal disorders, such as disc degeneration, deformity, and lateral disc herniation. With this technique, visualization is limited in comparison with the open procedure and the proximity of the lumbar plexus to the surgical pathway is one limitation of this technique. Precise knowledge of the regional anatomy of the lumbar plexus is required for safe passage through the psoas muscle. The primary objective of this study was to determine the anatomic position of the lumbar plexus branches and sympathetic chain in relation to the intervertebral disc and to define a safe working zone. The second objective was to compare our observations with previous anatomical studies concerning the transpsoas approach.
methodsA total of 60 lumbar plexus in 8 fresh cadavers from the Department of Anatomy were analyzed in this study. Coronal and lateral X-Ray images were obtained before dissection in order to eliminate spine deformity or fracture. All cadavers were placed in a lateral decubitus position with a lateral bolster. Dissection of the lumbar plexus was performed. All nerve branches and sympathetic chain were identified. Intervertebral disc space from L1L2 to L4L5 was divided into four zones. Zone 1 being the anterior quarter of the disc, zone 2 being the middle anterior quarter, zone 3 the posterior middle quarter and zone 4 the posterior quarter. Crossing of each nervous branch with the disc was reported and a safe working zone was determined for L1L2 to L4L5 disc levels. A safe working zone was defined by the absence of crossing of a lumbar plexus branch.
resultsNo anatomical variation was found during blunt dissection. As described previously, the lumbar plexus is composed of the ventral divisions of the first four lumbar nerves and from contributions of the sub costal nerve from T12. The safe working zone includes zones 2 and 3 at level L1L2, zone 3 at level L2L3, zone 3 at level L3L4, and zone 2 at level L4L5. No difference was observed between right and left sides as regards the relationships between the lumbar plexus and the intervertebral disc.
conclusionWe observed some differences concerning the safe working zone in comparison with other cadaveric studies. The small number of cadaveric specimens used in anatomical studies probably explains theses differences. The minimally invasive transpsoas lateral approach was initially developed to reduce the complications associated with the traditional procedure. The anatomical relationships between the lumbar plexus and the intervertebral disc make this technique particularly risky a L4L5. Alternative techniques, such as transforaminal interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF) or anterior interbody fusion (ALIF) should be used at this level.
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