10 Lateral Retractor Systems

Mohammed Abbas, Benjamin Khechen, Brittany E. Haws, Jordan A. Guntin, Kaitlyn L. Cardinal, and Kern Singh

10 Lateral Retractor Systems

10.1 Introduction

Of the various minimally invasive surgery (MIS) approaches, the lateral transpsoas approach has been extensively studied in regard to complications related to surgical exposure. During this approach, retraction systems traverse the psoas muscle, placing the psoas muscle and lumbar plexus at considerable risk of injury. Symptoms are typically transient and include thigh pain, groin pain, paresthesias, numbness, hip flexor weakness, and psoas spasm. ¹ ^, ² ^, ³ ^, ⁴ ^, ⁵ ^, ⁶ ^, ⁷ ^, ⁸ ^, ⁹ Avoidance of complications can be mediated by proper placement of tubular dilators and retraction systems. Additionally, the use of real-time neuromonitoring has reduced the incidence of neurologic injury via detection of nearby neural structures and subsequent adjustment of the approach by the surgeon. ¹⁰ ^, ¹¹

10.2 Lateral Retractor Systems

**Table 10.1** DePuy Synthes INSIGHT® Lateral Access System
Retractor design
Retractor system Expandable	Retractor apparatus Dual tubular blades	Design feature Bifurcated direct light source

Specifications
Blade winglets Length extension up to 10 mm Width extension up to 7 mm	Tubular blades Lengths: 80–180 mm (10-mm increments) Toeing: up to 20° angulation	Posterior disk anchor blade Lengths: 80–160 mm (10-mm increments)
Procedure
MIS LLIF, MIS decompression
Radiographs unavailable
Compatible device
DePuy Synthes COUGAR® LS Lateral Cage System

**Table 10.2** Globus Medical MARS™ 3V Minimal Access Retractor System
Design
Design feature 4th blade attachment, widening and lengthening shims to reduce muscle creep	Retractor system Expandable	Retractor apparatus Tubular blade

Specifications
Posterior and cephalad–caudal blade lengths 40–170 mm (10-mm increments)	Port composition Polyetheretherketone (PEEK)	Angulation Up to 20° independent blade angulation
Procedures
MIS LLIF, MIS decompression
Radiographs unavailable
Compatible devices
Globus Medical Lateral Fusion Systems

**Table 10.3** K2 M RAVINE® Lateral Access System
Retractor design
Retractor system Expandable	Retractor apparatus Dual flat blade platform	Design feature Polyetheretherketone (PEEK) port composition

Specifications
Blade diameters Flat blades: 24 mm Anteroposterior (AP) blades: 13 mm	Flat blades Lengths: 80–160 mm (10-mm increments)	AP blades Lengths: 80–160 mm (10-mm increments)
Procedure
MIS LLIF, MIS decompression

Compatible devices
K2 M ALEUTIAN® Lateral Interbody System

**Table 10.4** NuVasive MaXcess® 4 Access System
Retractor design
Retractor system Expandable	Retractor apparatus Tubular blade	Design feature Locking intradiskal shim improves retractor stability

Specifications
Tubular blade lengths 50–160 mm (10-mm increments)	Dilator diameters 6, 9, and 12 mm
Procedures
MIS LLIF, MIS decompression

Compatible devices
NuVasive CoRoent® XL Platform, StruXureTM XLIF decade

**Table 10.5** Zimmer Biomet AccuVision® Minimally Invasive Spinal Exposure System
Retractor design
Retractor system Expandable	Retractor apparatus Flat blade	Design feature Supplemental retractor module provides additional mediolateral exposure

Specifications
Tubular blade widths and lengths 18 mm × 40–110 mm (10-mm increments) 25 mm × 40–110 mm (10-mm increments)	Flat blade lengths 40–110 mm (10-mm increments)	Dilator diameters 7, 12, 18, 22, 25 mm
Procedures
MIS LLIF, MIS decompression
Radiographs unavailable
Compatible devices
Zimmer Biomet Lateral Fixation Systems

**Table 10.6** Zimmer Biomet Timberline® Lateral Fusion System
Retractor design
Retractor system Expandable	Retractor apparatus Tubular blade	Design feature Integrated posterior shim reduces retractor migration

Specifications	Posterior blade lengths 50–180 mm (10-mm increments) Toeing: Up to 20° angulation	Cephalad–caudal blade lengths 50–180 mm (10-mm increments) Up to 17 mm of retraction
Procedures
MIS LLIF, MIS decompression

Compatible devices
Zimmer Biomet Lateral Fusion Systems