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Direct Look > LLIF > Flashcards

LLIF Flashcards

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
Q

LLIF procedure uses what kind of decompression

A

Indirect Decompression

26
Q

What grade spondylolysthesis is suggested for LLIF procedures

A

Grade 1 or lower

27
Q

Name the two ligament of the anterior spine

A

ALL and PLL

28
Q

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

A

Aorta

29
Q

What ligament is between the disc space and the great vessels

A

ALL

30
Q

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

A

PLL

31
Q

L5-S1 is not indicated for LLIFs because all excepts

A

Sacro- iliac joint is too posterior

32
Q

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

A

True

33
Q

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

A

True

34
Q

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

A

True

35
Q

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

A

False

36
Q

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

A

True

37
Q

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

A

L2,L3 ,L4

38
Q

Genitofemoral nerve originate from what two nerve roots?

A

L1, L2

39
Q

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

A

L2, L3

40
Q

MIS illumination cannot be used with the direct look peritoneal retractor

A

False

41
Q

Before dissecting through the psoas, you should first

A

Release the psoas fascia

42
Q

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

A

True

43
Q

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

A

False

44
Q

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

A

False

45
Q

The iliohypogastric and the ilioinguinal nerves are located in the

A

Abdominus Muscles

46
Q

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

A

False

47
Q

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

A

Transverse abdominis muscles

48
Q

A group of nerves contained within the psoas muscle

A

Lumbar plexus

49
Q

The iliohypogastric and the ilioinguinal nerves travel between the

A

Transverse Abdominis and internal oblique muscles

50
Q

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

A

Genitofemoral

51
Q

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

A

True

52
Q

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

A

False

53
Q

SSEP STANDS FOR

A

Somatosensory Evoked Potential

54
Q

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

A

True

55
Q

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

A

True

56
Q

MEP STANDS FOR

A

Motor Evoked potential

57
Q

The height ranges for lordotic caliber L spacers are

A

7-11 mm w/ 6 deg lordosis

10-13mm w/10 deg lordosis

12-18mm w/10 deg lordosis

58
Q

The caliber L spacers have the following widths

A

16, 18, 22

59
Q

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

A

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

60
Q

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

A

7mm

61
Q

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

A

7

Direct Look (4 decks)

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