LLIF

Question 1

What 2 parts are made up of the abdominal cavity

Answer 1

Peritoneum

And retro peritoneum

Question 2

What organs are in the peritoneum

Answer 2

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

Question 3

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

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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

Answer 5

Psoas muscle

Question 6

What does the psoas major and iliacus make up?

Answer 6

The ilio psoas and are largely responsible for hip flexion

Question 7

What bundle of nerves are contained within the psoas muscle?

Answer 7

Lumbar plexus

Question 8

What’s the lumbar plexus

Answer 8

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

Question 9

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

Answer 9

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

Question 10

What does the lumbar plexus begin as?

Answer 10

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

Question 11

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

Answer 11

L1, L2, L3, L4

Question 12

ILiohypogastric nerve

Answer 12

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

Question 13

Ilioinguinal nerve

Answer 13

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

Question 14

Genitofemoral nerve

Answer 14

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.

Question 15

Lateral cutaneous nerve of the thigh

Answer 15

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

Question 16

Obturator Nerve

Answer 16

Nerve Roots: L2,L3,L4

Sensory Function: Innervates the skin over the medial thigh

Question 17

Femoral Nerve

Answer 17

Nerve Roots: L2, L3, L4

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

Question 18

What are the 3 abdominal muscles from lateral approach ?

Answer 18

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

Question 19

The centra part of a intervertebral disc is called

Answer 19

Nucleus pulposes

Question 20

Which of the nerves has a primary motor function

Answer 20

Genitofemoral nerve

Question 21

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

Answer 21

1. External oblique
   2.internal oblique
   Transverse Abdominous

Question 22

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

Answer 22

L 5

Question 23

The primary function of a ligament

Answer 23

Restrain motion

Question 24

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

Answer 24

Retroperitoneal fat

Question 25

LLIF procedure uses what kind of decompression

Answer 25

Indirect Decompression

Question 26

What grade spondylolysthesis is suggested for LLIF procedures

Answer 26

Grade 1 or lower

Question 27

Name the two ligament of the anterior spine

Answer 27

ALL and PLL

Question 28

Of the great vessels, which is on the left side of the body

Answer 28

Aorta

Question 29

What ligament is between the disc space and the great vessels

Answer 29

ALL

Question 30

What ligament is between the disc space and the vertebral fora men

Answer 30

PLL

Question 31

L5-S1 is not indicated for LLIFs because all excepts

Answer 31

Sacro- iliac joint is too posterior

Question 32

True/False, Degenerative Scoliosis is an indication for LLIF?

Answer 32

True

Question 33

True/false, LLIF can be a MIS alternative to Tlif, Plif, and ALIF ?

Answer 33

True

Question 34

True/false, Bilateral kidney surgery patients are not candidates for retroperitoneal surgery?

Answer 34

True

Question 35

True/false, muscle stripping is a benefit of LLIF?

Answer 35

False

Question 36

TRUE/FALSE, LLIF is a great alternative to ALIF ?

Answer 36

True

Question 37

The obturator and the femoral Nerve originate from what nerve roots?

Answer 37

L2,L3 ,L4

Question 38

Genitofemoral nerve originate from what two nerve roots?

Answer 38

L1, L2

Question 39

The lateral cutaneous nerve of the thigh originate from what two nerves

Answer 39

L2, L3

Question 40

MIS illumination cannot be used with the direct look peritoneal retractor

Answer 40

False

Question 41

Before dissecting through the psoas, you should first

Answer 41

Release the psoas fascia

Question 42

Patient positioning and taping are the same for the standard LLIF technique and the Direct Look

Answer 42

True

Question 43

An atomic safe zones are alway reliable, as the lumbar plexus remains static even with movement of the patients lower extremities

Answer 43

False

Question 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

Answer 44

False

Question 45

The iliohypogastric and the ilioinguinal nerves are located in the

Answer 45

Abdominus Muscles

Question 46

When closing the Abdominus muscles, be sure to close all three abdominal layers so to avoid an abdominal hernia

Answer 46

False

Question 47

With the Direct a look technique , the ----- must be closed to prevent a possible abdominal hernia

Answer 47

Transverse abdominis muscles

Question 48

A group of nerves contained within the psoas muscle

Answer 48

Lumbar plexus

Question 49

The iliohypogastric and the ilioinguinal nerves travel between the

Answer 49

Transverse Abdominis and internal oblique muscles

Question 50

The psoas fascia is thick and houses the __________ nerve which needs to be mobilized.

Answer 50

Genitofemoral

Question 51

The ilioinguinal and iliohypogastric nerves yield sensation to parts of the abdomen and groin.

Answer 51

True

Question 52

With the direct look technique, upon closure, it is important to suture all three abdominal muscle layers

Answer 52

False

Question 53

SSEP STANDS FOR

Answer 53

Somatosensory Evoked Potential

Question 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

Answer 54

True

Question 55

The lateral femoral cutaneous nerve is purely a sensory nerve with no motor component

Answer 55

True

Question 56

MEP STANDS FOR

Answer 56

Motor Evoked potential

Question 57

The height ranges for lordotic caliber L spacers are

Answer 57

7-11 mm w/ 6 deg lordosis 10-13mm w/10 deg lordosis 12-18mm w/10 deg lordosis

Question 58

The caliber L spacers have the following widths

Answer 58

16, 18, 22

Question 59

The 3 height ranges for the parallel Caliber - L spacer are

Answer 59

8-11mm , 9-13mm, 11-16mm

Question 60

What are the smallest heights of Caliber-L 16 mm wide spacers?

Answer 60

7mm

Question 61

Globus Biomechanical testing for Caliber-L demonstrated _____ times the pullout resistance when compared to a traditional static spacer

Answer 61

7