Hohmann’s retractor
- Placed at tip of TP to help dissection
- Danger of damaging lumbar nerves: Sekharappa 2013
- Placement that can damage lumbar plexus:
- Anterior to transverse process and lateral to vertebral body
- Near the IAP in the axillae of the TP
- Nerve most likely pressed is the femoral nerve followed by the obturator nerve
- Especially at the L4 and L5 level.
- Associated anatomy:
- In cadavers:
- lumbar plexus was situated directly over the transverse process of vertebra with very little muscle fibers of psoas behind the plexus.
- Above L3 transverse process the L2 nerve root was situated medially close to L2 vertebral body, while just above L4 and L5 transverse process, the branches forming the femoral and obturator nerves progressively coursed away from the vertebral bodies.
- At the level of L4 vertebral body, femoral nerve was situated lateral to the vertebral bodies by about 1.5–2 cm
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