Introduction
Experience with Lateral Transpsoas Procedure
Still relatively new to this. Performed under 100 of these
procedures over the last 2 years with multiple surgeons. Experienced contact
with surgeons from all over the country at Oracle meetings and surgeon training
seminars across the county including Seattle, Las Vegas, Pennsylvania, Atlanta
and San Diego. Trained the Oracle sales reps. Advise to attend surgeon training
seminars if possible.
Why this procedure is good:
- Muscle preservation-
- Avoids disruption
of kinetic chain of posterior lumbar muscles/ligaments.
- Avoids the effects
of denervation of denervation of paraspinal musculature.
- Minimal skin incision
- Reduced blood loss
- Minimization of
postoperative pain
- Allows for
retriperitoneal exposure of L1-L5 discs
- Allows for a more
complete discectomy
- Larger fusion area
than PLIF/TLIF
- Tall discs- not
optimal for PLIF/TLIF
- Reduced risk of damage
to abdominal vicera (anterior approach)
- Easier Access for
obese patients
- No need for access
surgeon as is common with anterior approaches
- No need for retraction
of aorta, vena cava, iliac artery, vein, calcified aorta (anterior approach)
- Faster recovery and
reduction of length of hospital stay= reduced costs
Limitations
-
Can’t
access L5-S1 disc (not only because of the illiac crest but also because
of neurovascular issues).
-
L4-L5
occasionally can not be accessed
-
Decompression is indirect (can’t get to the canal itself)
Anatomy –
-
Visual Human for overall view of the relevant structures.
-
Animation of Stim Probe- Explanation of T-EMG
-
Animation of lumbar plexus and associated nerves.
Neuromonitoring
Set up:
Positioning for Incision with Floroscopy:
Approach:
