Lateral Transpsoas Retractor Technology

Fig. 14.1
Photograph showing the MaXcess® (NuVasive, Inc.) retractor with detachable handle, table mount, and anterior retractor


Fig. 14.2
Intraoperative illustrations showing evoked-EMG stimulation in MaXcess off the posterior (center) blade electrode over the sequential dilators while rotating (a, b) the retractor to provide directional and distance EMG information about motor nerves posterior to the retractor

The MaXcess retractor’s primary feature is a split-blade design, with three main blades, one in the posterior orientation to the surgical approach and one each in cranial and caudal orientations (Fig. 14.3). The diameter of the closed blades is approximately 12 mm. Each of these blades can be manipulated independently of each other both to retract separately in cranial, caudal, and/or anterior orientations (by the cranial-caudal blades) simultaneously and posteriorly, if needed, by the posterior blade (Fig. 14.4). Each of the cranial and caudal blades can also be splayed either inwardly or outwardly to allow for additional or less cranial or caudal surgical site exposure without extension of the surgical incision (Fig. 14.5). Light sources are placed into each of the cranial and caudal blades for visualization of the lateral disk and working space (Fig. 14.6). A shim is placed down the posterior blade and into the disk space to hold the retractor in the chosen position. A fourth retractor blade can be placed anterior to the cranial and caudal blades, primarily to realize the potential space anterior to the anterior longitudinal ligament (ALL) or to provide a barrier between those structures and the working space (Fig. 14.1). Intraoperatively, the MaXcess retractor allows for broad visibility of the working corridor and disk space (Fig. 14.7).


Fig. 14.3
Illustration of the surgeon’s point of view in XLIF® (NuVasive, Inc.), with the three unretracted blades of the MaXcess retractor (posterior, cranial, and caudal) with a K-wire in the disk space and the NVM5® (NuVasive, Inc.) stimulating electrode shown in the posterior blade


Fig. 14.4
Lateral illustration showing the MaXcess retractor with anterior-only retraction by the cranial and caudal retractor blades with the posterior blade NVM5 EMG electrode and visual discrete threshold feedback clip (green clip on electrode)


Fig. 14.5
Anterior illustration of XLIF with MaXcess showing individual blade splay for surgical site expansion or retraction without change in incision size


Fig. 14.6
Surgeon’s point of view illustration in XLIF showing the MaXcess retractor with lighting elements in place in each of the cranial and caudal blades


Fig. 14.7
Anterior intraoperative fluororadiography showing and XLIF corpectomy using the MaXcess retractor and the anterior (fourth blade) spatula attachment for lung deflection

Categorically, the features of the MaXcess retractor include:

Sep 23, 2017 | Posted by in NEUROLOGY | Comments Off on Lateral Transpsoas Retractor Technology
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