European Spine Journal

, Volume 28, Issue 4, pp 835–841 | Cite as

Anatomic evaluation of retroperitoneal organs for lateral approach surgery: a prospective imaging study using computed tomography in the lateral decubitus position

  • Jun OuchidaEmail author
  • Tokumi Kanemura
  • Kotaro Satake
  • Hiroaki Nakashima
  • Naoki Segi
Original Article



The aim of this study is to investigate retroperitoneal organ distribution with the retroperitoneal approach in the lateral decubitus position.


We enrolled 100 patients scheduled for lateral approach surgery, including LIF and lateral corpectomy. We performed computed tomography with lateral decubitus positioning (L-CT) to assess the position of the organs, including abdominal aorta, kidney, descending colon, ureter, and gonadal artery. Anteroposterior organ positions were divided into four zones: A, anterior to the anterior margin of the vertebral body; AL, anterior margin to the middle line of the vertebral body; PL, middle line to the posterior margin of the vertebral body; and P, posterior to the posterior margin of the vertebral body. We defined zone PL–P as the “approach zone.” Measurements obtained using L-CT were compared with those obtained in the conventional supine position (S-CT).


Retroperitoneal organs in the approach zone significantly decreased in lateral positioning. Eighty-three percent of kidney and 20% of descending colon remain in the approach zone in L-CT. Sixty-six percent of disk levels recorded for the descending colon in zone P in S-CT remained in the approach zone even in L-CT.


We observed anterior migration in L-CT in all retroperitoneal organs. However, a considerable percentage of kidney and that of descending colon remain obstruent while performing LIF. We discuss that the preoperative imaging evaluation is beneficial, and gentle and meticulous surgical detachment is essential for safe and reliable lateral approach surgery, especially in the case that the descending colon extends outside zone P in S-CT.

Graphical abstract

These slides can be retrieved under electronic supplementary material.


Lumbar spine 1 Fusion 2 Complication 3 Lateral access surgery 4 Visceral injury 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

586_2018_5803_MOESM1_ESM.pptx (133 kb)
Supplementary material 1 (PPTX 134 kb)


  1. 1.
    Moller DJ, Slimack NP, Acosta FL Jr, Koski TR, Fessler RG, Liu JC (2011) Minimally invasive lateral lumbar interbody fusion and transpsoas approach-related morbidity. Neurosurg Focus 31:E4. CrossRefGoogle Scholar
  2. 2.
    Malham GM, Parker RM, Goss B, Blecher CM (2015) Clinical results and limitations of indirect decompression in spinal stenosis with laterally implanted interbody cages: results from a prospective cohort study. Eur Spine J 24(Suppl 3):339–345. CrossRefGoogle Scholar
  3. 3.
    Oliveira L, Marchi L, Coutinho E, Pimenta L (2010) A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine (Phila Pa 1976) 35:S331–S337. CrossRefGoogle Scholar
  4. 4.
    Berjano P, Balsano M, Buric J, Petruzzi M, Lamartina C (2012) Direct lateral access lumbar and thoracolumbar fusion: preliminary results. Eur Spine J 21(Suppl 1):S37–S42. CrossRefGoogle Scholar
  5. 5.
    Rodgers WB, Gerber EJ, Patterson J (2011) Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976) 36:26–32. CrossRefGoogle Scholar
  6. 6.
    Sofianos DA, Briseno MR, Abrams J, Patel AA (2012) Complications of the lateral transpsoas approach for lumbar interbody arthrodesis: a case series and literature review. Clin Orthop Relat Res 470:1621–1632. CrossRefGoogle Scholar
  7. 7.
    Tormenti MJ, Maserati MB, Bonfield CM, Okonkwo DO, Kanter AS (2010) Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurg Focus 28:E7. CrossRefGoogle Scholar
  8. 8.
    Uribe JS, Deukmedjian AR (2015) Visceral, vascular, and wound complications following over 13,000 lateral interbody fusions: a survey study and literature review. Eur Spine J 24:386–396CrossRefGoogle Scholar
  9. 9.
    Youssef JA, McAfee PC, Patty CA, Raley E, DeBauche S, Shucosky E, Chotikul L (2010) Minimally invasive surgery: lateral approach interbody fusion: results and review. Spine (Phila Pa 1976) 35:S302–S311. CrossRefGoogle Scholar
  10. 10.
    Ozgur BM, Aryan HE, Pimenta L, Taylor WR (2006) Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:435–443. CrossRefGoogle Scholar
  11. 11.
    Knight RQ, Schwaegler P, Hanscom D, Roh J (2009) Direct lateral lumbar interbody fusion for degenerative conditions: early complication profile. J Spinal Disord Tech 22:34–37. CrossRefGoogle Scholar
  12. 12.
    Anand N, Baron EM (2013) Urological injury as a complication of the transpsoas approach for discectomy and interbody fusion. J Neurosurg Spine 18:18–23. CrossRefGoogle Scholar
  13. 13.
    Aichmair A, Fantini GA, Garvin S, Beckman J, Girardi FP (2015) Aortic perforation during lateral lumbar interbody fusion. J Spinal Disord Tech 28:71–75. CrossRefGoogle Scholar
  14. 14.
    Assina R, Majmundar NJ, Herschman Y, Heary RF (2014) First report of major vascular injury due to lateral transpsoas approach leading to fatality. J Neurosurg Spine 21:794–798. CrossRefGoogle Scholar
  15. 15.
    Flouzat-Lachaniette CH, Delblond W, Poignard A, Allain J (2013) Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases. Eur Spine J 22:766–774. CrossRefGoogle Scholar
  16. 16.
    Moro T, Kikuchi S, Konno S, Yaginuma H (2003) An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. Spine (Phila Pa 1976) 28:423–428; discussion 427–428.
  17. 17.
    Fujibayashi S, Kawakami N, Asazuma T, Ito M, Mizutani J, Nagashima H, Nakamura M, Sairyo K, Takemasa R, Iwasaki M (2017) Complications associated with lateral interbody fusion: nationwide survey of 2998 cases during the first two years of its use in Japan. Spine (Phila Pa 1976). Google Scholar
  18. 18.
    Balsano M, Carlucci S, Ose M, Boriani L (2015) A case report of a rare complication of bowel perforation in extreme lateral interbody fusion. Eur Spine J 24(Suppl 3):405–408. CrossRefGoogle Scholar
  19. 19.
    Guerin P, Obeid I, Gille O, Bourghli A, Luc S, Pointillart V, Cursolle JC, Vital JM (2011) Safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: a morphometric study. Surg Radiol Anat 33:665–671. CrossRefGoogle Scholar
  20. 20.
    Sakai T, Tezuka F, Wada K, Abe M, Yamashita K, Takata Y, Higashino K, Sairyo K (2016) Risk management for avoidance of major vascular injury due to lateral transpsoas approach. Spine (Phila Pa 1976) 41:450–453. CrossRefGoogle Scholar
  21. 21.
    Prassopoulos P, Gourtsoyiannis N, Cavouras D, Pantelidis N (1990) A study of the variation of colonic positioning in the pararenal space as shown by computed tomography. Eur J Radiol 10:44–47CrossRefGoogle Scholar
  22. 22.
    Hopper KD, Sherman JL, Luethke JM, Ghaed N (1987) The retrorenal colon in the supine and prone patient. Radiology 162:443–446CrossRefGoogle Scholar
  23. 23.
    Prassopoulos P, Gourtsoyiannis N, Cavouras D, Pantelidis N (1994) Interposition of the colon between the kidney and the psoas muscle: a normal anatomic variation studied by CT. Abdom Imaging 19:446–448CrossRefGoogle Scholar
  24. 24.
    Kanemura T, Satake K, Nakashima H, Segi N, Ouchida J, Yamaguchi H, Imagama S (2017) Understanding retroperitoneal anatomy for lateral approach spine surgery. Spine Surgery and Related Research 1:107–120CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jun Ouchida
    • 1
    Email author
  • Tokumi Kanemura
    • 1
  • Kotaro Satake
    • 1
  • Hiroaki Nakashima
    • 1
  • Naoki Segi
    • 1
  1. 1.Department of Orthopedic SurgeryKonan Kosei Hospital, Japan Agricultural Cooperatives AichiKonanJapan

Personalised recommendations