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1. Neurosurgery Case Review: Questions and Answers

Author

Christian A. Bowers, Flavio Giordano, Faisal Abdulhamid Farrash, Pascal M. Jabbour, Alan Siu, Ramez Malak, Donald C. Shields, Unwar Ul-Haq, Jared J. Marks, Francisco Sanz, Achal Patel, Edward C. Benzel, Nabeel S. Alshafai, Hasel W. Slone, Jason S. Goldberg, Fahad Eid Alotaibi, Mohammad Almubaslat, Kamlesh B. Patel, Glenn C. Hunter, Anna Zicca, Michel Lacroix, Ibrahim Althubaiti, H. Francis Farhadi, Ahmed Mohyeldin, Robert L. Tiel, Homoud Aldahash, Claude-Edouard Châtillon, Franco DeMonte, Ossama Al-Mefty, Roberto Rafael Herrera, Nicholas J. Erickson, Nazer H. Qureshi, André Beer-Furlan, Judith Marcoux, Abdulrahman Yaqub Alturki, Ahmed Alaqeel, Badih Daou, Turki Elarjani, Sandeep Mittal, Kathleen E. Knudson, Alvin Chan, Amin B. Kassam, Kelsey A. Walsh, Mohammed Alghamd, Alfio Spina, Richard Bucholz, Fred Gentili, Marguerite Harding, Ricardo L. Carrau, Alwin Camacho, Pablo González-López, Faisal Al-Otaibi, Cristian Gragnaniello, Abdulrahman J. Sabbagh, Asem Salma, Stephen J. Hentschel, Joung H. Lee, Fahad AlKherayf, Rory Mayer, Rihaf Algain, John Woulfe, Stephen M. Russell, Han Zhuang Beh, Perry S. Bradford, Andrew Smith, Frederick Boop, Jorge E. Isaza, Vishal Patel, Eddie Perkins, Abdulrahman Albakr, Ibrahim Omeis, Christopher D. Baggott, Kevin Petrecca, Bassem Yousef Sheikh, Shaymaa Al-Umran, Michele Bailo, Jonathon Lebovitz, Pratap Chand, Edgar Gerardo Ordóñez-Rubiano, Aaron S. Gaekwad, Mohammed Almekhlafi, Jonathan Yun, Dimitri Sigounas, Julius July, Joseph A. Shehadi, Gustavo D. Luzardo, Ennio Antonio Chiocca, Shaan M. Raza, Alberto L. Gallotti, Anup Aggarwal, Ali Luqman, Mohammad A. Aziz-Sultan, Isabella Esposito, Eka Julianta Wahjoepramono, Imad N. Kanaan, Abdulrazag Ajlan, Hosam Al-Jehani, Brian Gill, Jaime Gasco, Brian Seaman, William T. Couldwell, José Luis Ledesma, Gary L. Gallia, Ananth K. Vellimana, Mark G. Hamilton, Da’Marcus Baymon, Almunder Algird, Evan S. Marlin, Ahmad I. Lary, Rudiger Von Ritschl, Afnan Uthman Alkhotani, Kevin Phan, Ayman Abdullah Albanyan, Essam A. Al Shail, Joshua Loewenstein, Mohammad Misfer Alshardan, Denis Klironomos, Ehtesham Ghani, Hector P. Rojas, Jeffery Atkinson, Matthew D. Smyth, Eldad J. Hadar, Erol Veznedaroglu, Mark A. Mahan, Qasim Al Hinai, Iván Verdú-Martínez, Peter J. Mews, Mohamed A. Labib, Randy L. Jensen, Rahul Shah, Amal Mokeem, Rolando Del Maestro, Denis Sirhan, Albert M. Isaacs, José Luis Montes, Mariam Alrashid, Jason Tullis, Hussam Abou-Al-Shaar, Justin Reagan, Daniel S. Ikeda, Pietro Mortini, David Sinclair, Hubert Lee, Mazda K. Turel, Michael S. Taccone, Alexander Y. Lin, Stephano Chang, Patrick Kim, Paul Steinbok, Luke G. F. Smith, Sami Obaid, Ashwag Al-Qurashi, Andrew Shaw, Abdul Haseeb Naeem, Exequiel P. Verdier, Ahmed Jaman Alzahrani, Lahbib A. Soualmi, Remi Nader, Ralph J. Mobbs, Soha Abdu M. Alomar, Mohammed Saeed Bafaqeeh, Zachary N. Litvack, Weston T. Northam, Joaquin Hidalgo, Robert F. Keating, Amgad S. Hanna, Jared Fridley, Bassam M. J. Addas, Monish Maharaj, Diana Ghinda, Daniel M. Prevedello, John S. Myseros, Lorenzo Genitori, Layla Batarfi, Khalid N. Almusrea, Samer K. Elbabaa, Adam Sauh Gee Wu, Anthony M. T. Chau, Naif M. Alotaibi, Saleh S. Baeesa, Kimberly Hamilton, Franz L. Ricklefs, Hashem Al Hashemi, Lissa Marie Peeling, Gareth Rutter, Sohum Desai, Philippe Mercier, Daniel Branch, Jorge E. Alvernia, Craig C. Weinkauf, Sunil Kukreja, Michel W. Bojanowski, Paul W. Gidley, Reem Bunyan, Domenic P. Esposito, Salah Baz, Randall C. Edgell, Christopher Evan Stewart, Burak Sade, Frank Gerold, Ali Alwadei, Nancy McLaughlin, Christopher J. Winfree, Terence Verla, Marc-Elie Nader, Andrew Jea, Filippo Gagliardi, Jean-Pierre Farmer, Giuliana Rizzo, Jeffrey P. Mullin, Ahmed T. Abdelmoity, Eric P. Roger, Anish Sen, Ivona Nemeiko, Mahmoud AlYamany, Anthony J. Caputy, Peter Nakaji, Nirmeen Zagzoog, Charles B. Agbi, Khalid Bajunaid, Matthew Pierson, Juan Ortega-Barnett, Justine Pearl, Maqsood Ahmad, Abdulmajeed Alahmari, and Robert A. Moumdjian

Subjects
Questions and answers, medicine.medical_specialty, Medical education, business.industry, medicine, Neurosurgery, business, Neuroscience, Case review
Published
2020

2. Morphometric anatomy of the lumbar sympathetic trunk with respect to the anterolateral approach to lumbar interbody fusion: a cadaver study

Author

Fiona Stewart, Gareth Rutter, Kevin Seex, Cristian Gragnaniello, Adam Smith, and Kevin Phan

Subjects
030222 orthopedics, business.industry, medicine.medical_treatment, Anatomy, Sagittal plane, 03 medical and health sciences, 0302 clinical medicine, Lumbar, medicine.anatomical_structure, Lumbar sympathetic trunk, Lumbar interbody fusion, Cadaver, Discectomy, medicine, Calipers, Original Study, Orthopedics and Sports Medicine, Surgery, Lumbar spine, business, 030217 neurology & neurosurgery
Abstract

Background: An approach to lateral lumbar interbody fusion (LLIF) utilizing an oblique corridor anterior to the psoas muscle was first described by Mayer in 1997 and subsequently by other authors. The only consistent structure of note in this corridor is the lumbar sympathetic trunk (LST), which at times must be mobilized in order to perform a discectomy and interbody fusion, thereby placing the LST at risk. This study was designed to describe the morphometric anatomy of the LST in relation to surgically relevant landmarks for the anterolateral approach to the lumbar spine at L3/L4 to L5/S1. Methods: Twenty-four embalmed cadavers (13 males, 11 females, age range, 50–89) were dissected to expose the LST. Bilateral measurements were recorded using a calliper under direct visualization, using the midsagittal plane of the lumbar spine as the reference landmark. The points were then marked with radio-opaque needles, and 14 cadavers were scanned with CT to validate the measurements. Results: Of 48 LSTs, there was minimal difference in the direction of its course between sides; 14/24 specimens had concordant directions. The majority (n=28) had a medial to lateral cephalocaudal course. If osteophytes were present at the L4/L5 level, the majority of LSTs (n=7, of 8) were displaced lateral to the osteophyte. At the L5/S1 level, half of the cases with osteophytes (n=3, of 6) stretched the LST over the top of the osteophyte. The LST was adherent to the L4/L5 disc space bilaterally in 93% of cases. Conclusions: With the development of lumbar fusion techniques which utilize an oblique corridor and the retraction of psoas muscle, LST has become an important neural structure to define, protect and mobilize. In our morphometric analysis of 24 specimens, the position has been identified and quantified, and this paper notes variations, particularly distortions caused by degenerative processes. In this study, the LST ran in a medial to lateral direction from L3 to S1, and osteophytes typically displace and adhere to the LST.

Published
2017

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