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Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: Cadaveric study and electrophysiological investigation: Laboratory investigation

Title
Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: Cadaveric study and electrophysiological investigation: Laboratory investigation
Authors
Fahim D.K.Kim S.D.Cho D.Lee S.Kim D.H.
Ewha Authors
조도상
SCOPUS Author ID
조도상scopus
Issue Date
2011
Journal Title
Journal of Neurosurgery: Spine
ISSN
1547-5654JCR Link
Citation
vol. 15, no. 5, pp. 532 - 540
Indexed
SCIE; SCOPUS WOS scopus
Abstract
Object. The thoracolumbar junction is frequently accessed through an anterolateral approach with the incision and muscle dissection extending from the lower thoracic region to the lateral border of the rectus abdominis muscle. This approach is frequently associated with the subsequent development of an unsightly and uncomfortable relaxation of the ipsilateral abdominal wall, or flank bulge, caused by denervation injury to the intercostal nerves. However, the etiology of this complication is not widely recognized by spine surgeons. The object of this study was to better define the relevant anatomy and innervation of the anterolateral abdominal wall musculature. Methods. The authors performed 32 cadaveric dissections and 6 intraoperative electromyography (EMG) evaluations. Results. The cadaveric dissection studies and intraoperative EMG evaluations provided detailed anatomy of the anterolateral abdominal wall and its innervation. Cadaveric dissections revealed that the most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T11 and T12. Electrophysiological confirmation of these findings was accomplished through intraoperative stimulation in 6 patients undergoing anterolateral retroperitoneal approaches to the thoracolumbar junction. The authors confirmed T11 and T12 innervation of the anterolateral abdominal wall musculature by direct intraoperative EMG recording in all 6 patients. Conclusions. The authors classified the 3 potential zones of injury that can be affected during an anterolateral approach to the thoracolumbar junction. Modifications to the operative technique are suggested to avoid the complication of flank bulge. The most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T11 and T12.
DOI
10.3171/2011.7.SPINE10887
Appears in Collections:
의학전문대학원 > 의학과 > Journal papers
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