A Posterior Oblique Approach to the Lumbar Disk Spaces, Vertebral Bodies, and Lumbar Plexus: A Cadaveric Feasibility Study.

ABSTRACT

STUDY DESIGN: A laboratory cadaveric study. OBJECTIVE: We aimed to demonstrate the feasibility of a posterior oblique approach, sharing the same advantages as the transpsoas technique while minimizing the risk of lumbar plexus or psoas muscle injuries. SUMMARY OF BACKGROUND DATA The transpsoas approach for interbody fusion and corpectomy offers advantages over posterior and anterior approaches. However, possible risks include traumatization of the psoas muscle or lumbar plexus. METHODS: All lumbar disk spaces and vertebral bodies were exposed by a posterior oblique approach from left and right on a human cadaveric specimen. The exposure obtained and a step-by-step documentation of the procedure is outlined in detail. RESULTS: We were able to achieve wide exposure of all lumbar disk spaces and vertebral bodies above the L5/S1 disk space. Only the psoas muscle was retracted, and the lumbar plexus nerves were easily visualized and gently retracted. Sharp dissection was only required around the tip of the transverse processes. CONCLUSIONS: A posterior oblique approach seems to be less invasive than the transpsoas approach. Exposure of the anterior column structures above the iliac crest is comparable. The oblique approach offers direct access to the lumbar plexus and the extraforaminal segments of the nerve roots.