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JOURNAL OF NEUROSURGICAL SCIENCES

Rivista di Neurochirurgia


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Journal of Neurosurgical Sciences 2017 December;61(6):579-88

DOI: 10.23736/S0390-5616.16.03498-6

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

MRI-based determination of convex or concave surgical approach for lateral lumbar interbody fusion in lumbar degenerative scoliosis: a retrospective radiographic comparative analysis

Myung-Hoon SHIN 1, Kyeong-Sik RYU 2

1 Department of Neurosurgery, Incheon St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea; 2 Department of Neurosurgery, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea


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BACKGROUND: We determined the optimal approach to perform lateral lumbar interbody fusion (LLIF) to treat lumbar degenerative scoliosis (LDS) by comparing the safe zone and psoas muscle on the concave and convex sides.
METHODS: Patients without scoliosis (N.=52) and those with levoscoliosis (N.=55) and dextroscoliosis (N.=53) were included. Vertebral anteroposterior diameter, overlap between the retroperitoneal vessels and the anterior edge of the vertebra, and overlap between the ventral nerve roots and the posterior edge of the vertebra were measured, and safe zones were calculated. The cross-sectional area (CSA) and fatty infiltration (FI) rate of the bilateral psoas muscle were measured, and the convex and concave sides were compared.
RESULTS: The ventral overlap on the convex side decreased at the L3-4 and L4-5 levels in the levoscoliosis group (P=0.05 and P=0.01, respectively) and at the L2-3 and L3-4 levels in the dextroscoliosis group (P=0.01 and P=0.03, respectively). The convex side at the L3-4 and L4-5 levels presented a greater safe zone in the levoscoliosis group (76.11% vs. 74.00% at L3-4, P=0.02; 69.37% vs. 63.16% at L4-5, P=0.00). The convex side at the L2-3, L3-4, and L4-5 levels in the dextroscoliosis group showed greater safe zones compared to those in the group without scoliosis (77.78% vs. 74.40% at L2-3, P=0.02; 72.15% vs. 69.87% at L3-4, P=0.03; and 58.45% vs. 54.39% L4-5 level, P=0.01). CSA of the psoas muscle on the concave side was significantly higher at the L2-3 and L3-4 levels (P=0.02 and 0.01, respectively). The psoas muscle on the concave side was significantly thicker (P=0.00 at all levels) with a higher FI rate.
CONCLUSIONS: The convex retroperitoneal vessels were positioned more anteriorly, whereas the ventral nerve roots lacked significant positional alterations, increasing the convex safe zone and providing optimal disc space access and less psoas muscle injury.


KEY WORDS: Minimally invasive surgical procedures - Lumbar vertebrae - Scoliosis

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Publication History

Issue published online: September 29, 2017
Article first published online: January 29, 2016
Manuscript accepted: January 25, 2016
Manuscript revised: January 19, 2016
Manuscript received: September 18, 2015

Per citare questo articolo

Shin MH, Ryu KS. MRI-based determination of convex or concave surgical approach for lateral lumbar interbody fusion in lumbar degenerative scoliosis: a retrospective radiographic comparative analysis. J Neurosurg Sci 2017;61:579-88. DOI: 10.23736/S0390-5616.16.03498-6

Corresponding author e-mail

novice97@hanmail.net