Dissection is continued anteriorly to expose the anterio-medial border of the psoas major muscle where the sympathetic chain is found. At this point, a retractor frame is installed and a single retractor blade is placed into the field to retract retroperitoneal fat anteriorly. A dissection plane is developed between the sympathetic chain and the anterior border of the psoas muscle. Bipolar cautery and sharp dissection is used to cut attachments and the psoas muscle is retracted posteriorly. Also the sympathetic plexus is dissected from the spine and retracted anteriorly by placing the anterior retractor blade posterior and medial to it. This maneuver usually exposes the anterior longitudinal ligament which should be preserved. Segmental vessels are coagulated clipped and cut if access to mid-vertebral body is required to insert a plate or other anterior support instrumentation.
DE in Latin means "down, away." So a descent is a downward slope or climb, and a decline is a downward slide (of health, income, etc.). To devalue something is to take value away from it. And you might describe a depressed friend as "down." Debase, to lower the value or reputation of someone or something. Defamation, the harming of someone's reputation by libel or slander. Degenerative, causing the body or part of the body to become weaker or less able to function as time passes. Dejection, sadness, depression, or lowness of spirits.
During psoas muscle dissection, small nerve branches may come into view and are retracted posteriorly together with the body of the muscle. A 2-cm working space is enough to obtain adequate access. Discectomy is performed in a routine fashion with contralateral annulotomy using a Cobb under AP fluoroscopic guidance. Once the cage is implanted attention is given to adjacent levels. The anterior border of the psoas muscle serves as the major landmark to extend the dissection inferiorly or superiorly. The same surgical corridor between the sympathetic chain and the muscle is developed further up or down. At the L4–5 level, the genitofemoral nerve comes close to the anterior psoas muscle border and therefore should be preserved by strict adherence to muscle detachment technique. Also at this level for a left-sided approach, the iliolumbar vessels should be ligated and sectioned to adequately retract the muscle.
NUL/NULL comes from the Latin word nullus, "none," which is itself a combination of ne-("not") and ullus ("any"). Have you ever noticed how many of our negative words start with n-? Think of no, not, never, nothing, none, no one, nowhere, and the hundreds of non-words-just about all of which go back to the same Greek root. Null, having no legal power; having no elements. Nullity, nothingness; a mere nothing. Nullify, to cancel legally; to cause something to lose its value or to have no effect. Annulment, an official statement that something is no longer valid.