Comparison of two techniques Satishchandra gore India
lumbar plexus always located in the posteriorthe third of psoas major muscle
anterior view, lumbar nerve, arranged from medial to lateral, from L5 to L2;
lateral view, lumbar nerve arranged from ventral to dorsal, from L2 to L5.
Figure 2 Morphometric Analysis of the Ventral Nerve Roots and Retroperitoneal Vessels With Respect to the Minimally Invasive Lateral Approach in Normal and Deformed Spines. Regev, Gilad; Chen, Lina; Dhawan, Mallika; Lee, Yu; Garfin, Steven; Kim, Choll; MD, PhD Spine. 34(12):1330-1335, May 20, 2009. DOI: 10.1097/BRS.0b013e3181a029e1 Figure 2 . An anatomic illustration of the surgical safe zone (white area), between the nerve roots and the right retroperitoneal vessel (vena cava). 2
Cadaveric photograph with overlay of the vertebral bodies and disc spaces as related to the psoas muscle. The blue line represents the lumbar contribution of the lumbosacral plexus that continues distally as the femoral nerve; note its more ventral location at L4–5.
Axial MRI image at L3–4 demonstrating measurements in relationship to the anterior intervertebral plane: a the anterior edge of the psoas muscle (extending just anterior to the intervertebral plane in this image), b the anterior aspect of the lumbar plexus, c the location of the femoral nerve beginning the L3–4 level, d the position of the posterior edge of either the inferior vena cava or right iliac vein depending on level, e the anteroposterior diameter of the psoas muscle. The diagram also includes measurement (f), the transverse distance between the lateral aspect of the intervertebral disc and the medial aspect of the lumbar plexus
message • There can only one best way of reaching target even though wide range is possible. • Stay close to transverse process and facet. • Plane of transverse process is physiological and anchor in intertransverse plane is good. • Coming at an angle initially is safe and more dependable. • Ventral relations of foramen are important.