EXTREME LATERAL LUMBAR FUSION

1. * 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.
   
   
2. * 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.
   
   
3. * 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.
   
   
4. 'Peel away' anatomy:
   * From the top, the prevertebral fascia
   * Annulus fibrosus of the disc
   * Nucleus pulposus of the disc
   * Vertebral body (cut in half)
   
   
5. * 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.
   
   
6. 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.
   
   
7. * 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.
   
   
8. * The three blades of the Maxcess retractor are opened further and fibreoptic lighting is attached to complete the working portal.
   
   
9. * 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.