The subcostal nerve during lateral approaches to the lumbar spine: Anatomic study with relevance for injury avoidance and postoperative complications such as abdominal wall hernia.

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The subcostal nerve during lateral approaches to the lumbar spine: Anatomic study with relevance for injury avoidance and postoperative complications such as abdominal wall hernia.

World Neurosurg. 2017 May 19;:

Authors: Alonso F, Graham R, Rustagi T, Drazin D, Loukas M, Oskouian RJ, Chapman JR, Tubbs RS

Abstract
INTRODUCTION: Lateral approaches to the spine have gained popularity. However, details of the innervation pattern of the abdominal oblique muscles with the initial dissection have not been well-studied.
METHODS: Ten adult fresh-frozen cadavers (20 sides) were placed in the lateral position. On each side, the region where transpsoas approaches are performed, between the iliac crest and 12th rib, was dissected. The nerves, their course and muscular supply were studied.
RESULTS: The subcostal nerve is the predominant nerve supply for the anterolateral abdominal muscle innervation. Regarding size, the subcostal nerve was largest in size and had a wider field of distribution and more branches (average eight) compared to the L1 (average four) or 11(th) intercostal nerves (average 2). The proximal 6-10 cm of each nerve had few if any branches. The subcostal nerve was often found (75%) located up to 5 cm inferior to the 12th rib in its initial course. The area of least concentration ("safe zone") was located at an approximate midpoint between the lower edge of the 12th rib and the superior-most aspect of the iliac crest. Additionally, a previously undescribed branch of the subcostal nerve was found traveling posterior to the quadratus lumborum and joining the remaining subcostal nerve in an anastomosis at or near the lateral position.
CONCLUSIONS: Knowledge of the innervation and nerve dominance patterns might help decrease postoperative complications like sensory deficits or abdominal wall hernias. The subcostal nerve is the dominant nerve in both size and innervation of the oblique muscles in the lateral position, transpsoas approach.

PMID: 28532913 [PubMed - as supplied by publisher]

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