- * Degenerative disc disease at L3/4 (third from bottom disc) and L4/5 (second from bottom disc).
* At L3/4 the exiting nerve root is shown exiting the foramen.
- * Exiting nerve roots are shown in blue. These go on to form the lumbar plexus within the psoas muscle.
* The XLiF approach stays anterior (in front of) these exiting nerves.
* The retractor is placed on the disc in front of the spinal canal and the nerve roots.
- * Cross-sectional anatomy of a disc.
* The X-LiF approach avoids the large blood vessels in the front and the nerves, dura and spinal fluid in the back.
- 'Peel away' anatomy:
* From the top, the prevertebral fascia
* Annulus fibrosus of the disc
* Nucleus pulposus of the disc
* Vertebral body (cut in half)
- * The lumbar plexus shown in blue courses through the psoas muscle on either side of the lumbar spine.
* Neurovision makes it possible to navigate through this without injuring these nerves.
- The neurovision probe is advanced through the substance of the psoas muscle in continuous monitoring mode. If it is too close to a nerve a the color changes to red and a value of 10 milliamps or less will be shown.
- * A guide wire is placed through the probe and anchored to the disc for stability.
* The three-blade Maxcess retractor is placed over the neurovision probe using X-ray flouroscopy to confirm correct placement.
- * The three blades of the Maxcess retractor are opened further and fibreoptic lighting is attached to complete the working portal.
- * The neurovision probe can sense if the channel being created is too close to a lumbar plexus nerve. If there is a green light then it is safe to proceed.
* Once the retractor is docked, work can begin on the disc space.
The Spine Center | Vietnam
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