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An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery.
Spine (Phila Pa 1976). 2003 Mar 01; 28(5):423-8; discussion 427-8.S

Abstract

STUDY DESIGN

The distribution of the lumbar plexus was analyzed using cadavers.

OBJECTIVE

To clarify the safety zone to prevent nerve injuries with respect to retroperitoneal endoscopic surgery.

SUMMARY OF BACKGROUND DATA

Surgical approaches to the retroperitoneal space vary among surgeons. Recently, retroperitoneal endoscopic surgery has been applied to various spinal disorders. When the psoas major muscle is separated during retroperitoneal endoscopic surgery, there is a potential risk of injury to the lumbar plexus or nerve roots. However, there is sparse knowledge regarding the relationship between the greater psoas muscle and the lumbar plexus.

METHODS

A total of 30 cadavers were analyzed. Six lumbar spines of the cadavers were cut in parallel with the lumbar disc space. Each axial section was photographed and captured into a computer. The distribution of the lumbar plexus was analyzed using computer images. The positions where the genitofemoral nerve emerged on the abdominal surface of the psoas major muscle were analyzed using 24 cadavers.

RESULTS

L2/3 and above, all parts of the lumbar plexus, and nerve roots were located from the dorsal fourth of the vertebral body and dorsally. The genitofemoral nerve descends obliquely forward through the psoas major muscle, emerging on the abdominal surface between the cranial third of the L3 vertebra and the caudal third of the L4 vertebra. The safety zone of the psoas major muscle to prevent nerve injuries, excluding the genitofemoral nerve, is at L4/L5 and above.

CONCLUSIONS

The safety zone, excluding the genitofemoral nerve, is at L4-L5 and above.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Fukushima Medical University, School of Medicine, Fukushima City, Japan. moro@fmu.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12616150

Citation

Moro, Takatomo, et al. "An Anatomic Study of the Lumbar Plexus With Respect to Retroperitoneal Endoscopic Surgery." Spine, vol. 28, no. 5, 2003, pp. 423-8; discussion 427-8.
Moro T, Kikuchi S, Konno S, et al. An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. Spine (Phila Pa 1976). 2003;28(5):423-8; discussion 427-8.
Moro, T., Kikuchi, S., Konno, S., & Yaginuma, H. (2003). An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. Spine, 28(5), 423-8; discussion 427-8.
Moro T, et al. An Anatomic Study of the Lumbar Plexus With Respect to Retroperitoneal Endoscopic Surgery. Spine (Phila Pa 1976). 2003 Mar 1;28(5):423-8; discussion 427-8. PubMed PMID: 12616150.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. AU - Moro,Takatomo, AU - Kikuchi,Shin-ichi, AU - Konno,Shin-ichi, AU - Yaginuma,Hiroyuki, PY - 2003/3/5/pubmed PY - 2003/3/26/medline PY - 2003/3/5/entrez SP - 423-8; discussion 427-8 JF - Spine JO - Spine (Phila Pa 1976) VL - 28 IS - 5 N2 - STUDY DESIGN: The distribution of the lumbar plexus was analyzed using cadavers. OBJECTIVE: To clarify the safety zone to prevent nerve injuries with respect to retroperitoneal endoscopic surgery. SUMMARY OF BACKGROUND DATA: Surgical approaches to the retroperitoneal space vary among surgeons. Recently, retroperitoneal endoscopic surgery has been applied to various spinal disorders. When the psoas major muscle is separated during retroperitoneal endoscopic surgery, there is a potential risk of injury to the lumbar plexus or nerve roots. However, there is sparse knowledge regarding the relationship between the greater psoas muscle and the lumbar plexus. METHODS: A total of 30 cadavers were analyzed. Six lumbar spines of the cadavers were cut in parallel with the lumbar disc space. Each axial section was photographed and captured into a computer. The distribution of the lumbar plexus was analyzed using computer images. The positions where the genitofemoral nerve emerged on the abdominal surface of the psoas major muscle were analyzed using 24 cadavers. RESULTS: L2/3 and above, all parts of the lumbar plexus, and nerve roots were located from the dorsal fourth of the vertebral body and dorsally. The genitofemoral nerve descends obliquely forward through the psoas major muscle, emerging on the abdominal surface between the cranial third of the L3 vertebra and the caudal third of the L4 vertebra. The safety zone of the psoas major muscle to prevent nerve injuries, excluding the genitofemoral nerve, is at L4/L5 and above. CONCLUSIONS: The safety zone, excluding the genitofemoral nerve, is at L4-L5 and above. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/12616150/An_anatomic_study_of_the_lumbar_plexus_with_respect_to_retroperitoneal_endoscopic_surgery_ L2 - https://doi.org/10.1097/01.BRS.0000049226.87064.3B DB - PRIME DP - Unbound Medicine ER -