LLIF Flashcards

(61 cards)

1
Q

What 2 parts are made up of the abdominal cavity

A

Peritoneum

And retro peritoneum

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2
Q

What organs are in the peritoneum

A

It’s a membrane that encloses many organs of the abdomen, intestines, stomach etc.

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3
Q

What’s the retroperitoneal space? And what is inside it?

A

It’s posterior to the peritoneal peritoneum. The surgeon will retract the peritoneum to go through the retro peritoneal space.

The psoas muscle, kidneys, bladder, aorta, vena cava

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4
Q

What muscle will the surgeon first cut in a lateral approve once in the retro peritoneal space

A

Psoas Fascia which in cases the psoas muscle and containing Genito femoral nerve

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5
Q

What is the deepest muscle in the lateral approach that sits over the disc space?

A

Psoas muscle

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6
Q

What does the psoas major and iliacus make up?

A

The ilio psoas and are largely responsible for hip flexion

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7
Q

What bundle of nerves are contained within the psoas muscle?

A

Lumbar plexus

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8
Q

What’s the lumbar plexus

A

Bundle of nerves that provides sensory and motor function to the lower region of the body. L1 - L4

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9
Q

At each vertebral level what canal do the spinal nerves leave from?

A

Paired of spinal nerves leave the spinal canal through the intervertebral foramina of the vertebral column then each nerve then divided into anterior and posterior nerve fibers

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10
Q

What does the lumbar plexus begin as?

A

The anterior fibers of the spinal nerves L1, L2, L3 and L4.

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11
Q

What nerves combine together to form the six major peripheral nerves of the lumbar plexus?

A

L1, L2, L3, L4

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12
Q

ILiohypogastric nerve

A

It’s the first major branch of the lumbar plexus. It runs to the iliac crest across the quadratus lumborum muscle of the posterior abdominal wall. Then perforates the transverse abdominus.

Nerve Roots: T12 and L1

Sensory function: innervates the pubic region

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13
Q

Ilioinguinal nerve

A

The illioinguinal nerve follows the same anatomical course as the larger iliohypogastric nerve.

After innervatting the muscles of the anterior abdominal wall it passes thru the superficial inguinal ring to innervates the skin of the genitalia and middle thigh.
Nerve root : L1
Sensory functions: innervates the skin on the upper middle thigh

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14
Q

Genitofemoral nerve

A

After leaving the psoas major muscle the Genito femoral nerve quickly divides into a genital and femoral branch.

Nerve roots: L1, L2

Sensory Function: the Genital branch innervates pubic region. The femoral branch innervates the skin on the upper anterior thigh.

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15
Q

Lateral cutaneous nerve of the thigh

A

This nerves has purely sensory function. It enters the thigh at the lateral aspect of the i quintal ligament where it provides cutaneous innervation to the skin there.

Nerve Roots: L2,L3

Sensory Function: Innervates the anterior and lateral thigh down to the level of the knee

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16
Q

Obturator Nerve

A

Nerve Roots: L2,L3,L4

Sensory Function: Innervates the skin over the medial thigh

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17
Q

Femoral Nerve

A

Nerve Roots: L2, L3, L4

Sensory Function: Innervates the skin on the anterior thigh and the medial leg

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18
Q

What are the 3 abdominal muscles from lateral approach ?

A

External oblique is the most superficial muscle in lateral approach

Internal oblique lies between the external and transverse Abdominus and runs perpendicular to the external Abdominus

Transverse Abdominus is the deepest layer of the abdominal muscles

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19
Q

The centra part of a intervertebral disc is called

A

Nucleus pulposes

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20
Q

Which of the nerves has a primary motor function

A

Genitofemoral nerve

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21
Q

List the order of the abdominal muscle layers from lateral to medial

A
  1. External oblique
    2.internal oblique
    Transverse Abdominous
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22
Q

What is the typical level you find the bifurcation of the great vessels

A

L 5

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23
Q

The primary function of a ligament

A

Restrain motion

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24
Q

In a lateral approach , what is between the transverse Abdominous and the psoas?

A

Retroperitoneal fat

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25
LLIF procedure uses what kind of decompression
Indirect Decompression
26
What grade spondylolysthesis is suggested for LLIF procedures
Grade 1 or lower
27
Name the two ligament of the anterior spine
ALL and PLL
28
Of the great vessels, which is on the left side of the body
Aorta
29
What ligament is between the disc space and the great vessels
ALL
30
What ligament is between the disc space and the vertebral fora men
PLL
31
L5-S1 is not indicated for LLIFs because all excepts
Sacro- iliac joint is too posterior
32
True/False, Degenerative Scoliosis is an indication for LLIF?
True
33
True/false, LLIF can be a MIS alternative to Tlif, Plif, and ALIF ?
True
34
True/false, Bilateral kidney surgery patients are not candidates for retroperitoneal surgery?
True
35
True/false, muscle stripping is a benefit of LLIF?
False
36
TRUE/FALSE, LLIF is a great alternative to ALIF ?
True
37
The obturator and the femoral Nerve originate from what nerve roots?
L2,L3 ,L4
38
Genitofemoral nerve originate from what two nerve roots?
L1, L2
39
The lateral cutaneous nerve of the thigh originate from what two nerves
L2, L3
40
MIS illumination cannot be used with the direct look peritoneal retractor
False
41
Before dissecting through the psoas, you should first
Release the psoas fascia
42
Patient positioning and taping are the same for the standard LLIF technique and the Direct Look
True
43
An atomic safe zones are alway reliable, as the lumbar plexus remains static even with movement of the patients lower extremities
False
44
Direct look should not be used at L4-L5 due to the more anterior location of the neural elements within the retro peritoneal space, as well as the anterior location of the psoas muscles and lumbar plexus
False
45
The iliohypogastric and the ilioinguinal nerves are located in the
Abdominus Muscles
46
When closing the Abdominus muscles, be sure to close all three abdominal layers so to avoid an abdominal hernia
False
47
With the Direct a look technique , the ----- must be closed to prevent a possible abdominal hernia
Transverse abdominis muscles
48
A group of nerves contained within the psoas muscle
Lumbar plexus
49
The iliohypogastric and the ilioinguinal nerves travel between the
Transverse Abdominis and internal oblique muscles
50
The psoas fascia is thick and houses the __________ nerve which needs to be mobilized.
Genitofemoral
51
The ilioinguinal and iliohypogastric nerves yield sensation to parts of the abdomen and groin.
True
52
With the direct look technique, upon closure, it is important to suture all three abdominal muscle layers
False
53
SSEP STANDS FOR
Somatosensory Evoked Potential
54
Incomplete release of the psoas fascia can increase intra neural strain within the femoral nerve and its branches from the tension generated on the psoas fascia by the pull of the retractor
True
55
The lateral femoral cutaneous nerve is purely a sensory nerve with no motor component
True
56
MEP STANDS FOR
Motor Evoked potential
57
The height ranges for lordotic caliber L spacers are
7-11 mm w/ 6 deg lordosis 10-13mm w/10 deg lordosis 12-18mm w/10 deg lordosis
58
The caliber L spacers have the following widths
16, 18, 22
59
The 3 height ranges for the parallel Caliber - L spacer are
8-11mm , 9-13mm, 11-16mm
60
What are the smallest heights of Caliber-L 16 mm wide spacers?
7mm
61
Globus Biomechanical testing for Caliber-L demonstrated _____ times the pullout resistance when compared to a traditional static spacer
7