Anatomical Relationships of the Anterior Blood Vessels to the Lower Lumbar Intervertebral Discs

Vaccaro, Alexander R.; Kepler, Christopher K.; Rihn, Jeffrey A.; Suzuki, Hidekazu; Ratliff, John K.; Harrop, James S.; Morrison, William B.; Limthongkul, Worawat; Albert, Todd J.

doi:10.2106/jbjs.k.00671

Cited by 38 publications

(36 citation statements)

References 22 publications

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“…Psoas disruption and its consequent inflammation is considered a possible cause of these postoperative symptoms. 38 Injury of the lumbar plexus as it courses through the psoas muscle is another potential source of postoperative neurological symptoms. 3,[13][14][15] Intraoperative neurological monitoring is said to decrease neural injury.…”

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confidence: 99%

“…There was some variation in the exact level as it relates to which third of the L-4 vertebral body, but these differences are probably due to normal anatomical variation. In a review of 30 MR images, Vaccaro et al 38 reported 73% of cases with an aortic bifurcation at L-4 and 57% of cases with a confluence of the common iliac veins at L-5. Our observations of the common iliac vein confluence had slightly more variation, with 34.67% at the L-5 vertebral body level, 45.92% at L-4, and 19.39% at the L4-5 disc level.…”

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confidence: 99%

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Retroperitoneal oblique corridor to the L2–S1 intervertebral discs: an MRI study

Molinares¹,

Davis²,

Fung³

2016

SPI

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OBJECT The purpose of this study was to analyze MR images of the lumbar spine and document: 1) the oblique corridor at each lumbar disc level between the psoas muscle and the great vessels, and 2) oblique access to the L5–S1 disc space. Access to the lumbar spine without disruption of the psoas muscle could translate into decreased frequency of postoperative neurological complications observed after a transpsoas approach. The authors investigated the retroperitoneal oblique corridor of L2–S1 as a means of surgical access to the intervertebral discs. This oblique approach avoids the psoas muscle and is a safe and potentially superior alternative to the lateral transpsoas approach used by many surgeons. METHODS One hundred thirty-three MRI studies performed between May 4, 2012, and February 27, 2013, were randomly selected from the authors’ database. Thirty-three MR images were excluded due to technical issues or altered lumbar anatomy due to previous spine surgery. The oblique corridor was defined as the distance between the left lateral border of the aorta (or iliac artery) and the anterior medial border of the psoas. The L5–S1 oblique corridor was defined transversely from the midsagittal line of the inferior endplate of L-5 to the medial border of the left common iliac vessel (axial view) and vertically to the first vascular structure that crossed midline (sagittal view). RESULTS The oblique corridor measurements to the L2–5 discs have the following mean distances: L2–3 = 16.04 mm, L3–4 = 14.21 mm, and L4–5 = 10.28 mm. The L5–S1 corridor mean distance was 10 mm between midline and left common iliac vessel, and 10.13 mm from the first midline vessel to the inferior endplate of L-5. The bifurcation of the aorta and confluence of the vena cava were also analyzed in this study. The aortic bifurcation was found at the L-3 vertebral body in 2% of the MR images, at the L3–4 disc in 5%, at the L-4 vertebral body in 43%, at the L4–5 disc in 11%, and at the L-5 vertebral body in 9%. The confluence of the iliac veins was found at lower levels: 45% at the L-4 level, 19.39% at the L4–5 intervertebral disc, and 34% at the L-5 vertebral body. CONCLUSIONS An oblique corridor of access to the L2–5 discs was found in 90% of the MR images (99% access to L2–3, 100% access to L3–4, and 91% access to L4–5). Access to the L5–S1 disc was also established in 69% of the MR images analyzed. The lower the confluence of iliac veins, the less probable it was that access to the L5–S1 intervertebral disc space was observed. These findings support the use of lumbar MRI as a tool to predetermine the presence of an oblique corridor for access to the L2–S1 intervertebral disc spaces prior to lumbar spine surgery.

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confidence: 99%

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confidence: 99%

Retroperitoneal oblique corridor to the L2–S1 intervertebral discs: an MRI study

Molinares¹,

Davis²,

Fung³

2016

SPI

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“…According to these results, it can be considered that LCIA was in a safer position at L4-5 level and pituitary punch had a higher probability of injuring and touching RCIA or LCIV localized between RCIA after passing ALL when they are compared in terms of fat plane existence between vascular structures and ALL. Vaccaro et al [2] notified that LCIV was closer to ALL than other vascular structures at L4-L5 level, and the same case continued at L5-S1. In our results, there was no significant difference between LCIV and RCIV at L4-5 IDL (p=0.081) but LCIV was closely located to ALL at L5-S1 level (p<0.001).…”

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confidence: 98%

Morphometric Analysis of Significant Vascular Structures in Posterior Disc Surgery in Computed Tomography Angiography

Altunrende

Ekin

2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Vascular injuries, which are rarely seen in all spinal area procedures, especially lumbar disc surgery, are vitally important. The relationship between the course of the iliac artery and vein and intervertebral disc distance was studied morphometrically in patients who had undergone computed tomography angiography for abdominal aorta. METHODS: This study was carried out retrospectively. A total of 100 patients who had undergone computed tomography angiography participated in the study. The aorta bifurcation, right and left common iliac artery (R/LCIA) and vein (R/LCIV), and the location of the common iliac artery bifurcation were investigated. The location of these vascular structures at the level of the spinal vertebral body and at the intervertebral disc level, determination of a fat plane between them, and the anterior longitudinal ligament (ALL) were analyzed. RESULTS: At the L4-5 intertransversarius dorsalis (IDL), the RCIV was determined to be at the 12 o'clock position RCIA in 51% of cases and between the ratio of 67% ALL. The LCIA was at the 1 o'clock position in 72% and adjacent to the ALL in 47%. The RCIV was located in the 11 o'clock position and there was no fat plane between the RCIV and the ALL in 92%. In 80%, the LCIV was located at the 11-12 o'clock position and in 18% transversely along the 12-1-2 o'clock region. There was no fat plane between the LCIV and the ALL in any patient. At the L5-S1 IDL, the RCIA was observed at the 10 o'clock position in 63%, and there was no fat plane between the RCIA and the ALL. The LCIA was at the 2 o'clock position in 72% and the LCIV was between the ALL and the LCIA in 92%. The RCIV was located at the 9-10 o'clock position in 95% and no fat plane was found between the ALL and the RCIV in 60%. The LCIV was located at the 1-2 o'clock position in 96% and there was no fat plane between the LCIV and the ALL in 92%; it was located close to the ALL. CONCLUSION: The L4-5 IDL RCIA was located at the midline and at a 30° angle position. The LCIV was located between them. The L5-S1 IDL located at LCIA left at 60° position was quite close to ALL with LCIV. When the distance from the ALL was compared and the frequency of fat planes between the ALL and the CIAs are considered, it can be noted that the RCIA in the L4-L5 IDL (p<0.001) and the LCIA in the L5-S1 IDL (p<0.001) were located remotely and in a more protected position. It should be kept in mind that the LCIV can progress along the L4-5 ID level, adjacent to the ALL, as well as transversely.

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“…The change of the localization of vessels in different patient positions during surgery is not fully investigated. In a study that focused on the posterior approach to the spine, Vaccaro et al 15 found that from supine to prone position, the vessels at L4-L5 did not move significantly. Deukmedjian and colleagues 6 simulated the lateral position used in LTIF.…”

Section: Patient Positioningmentioning

confidence: 99%

Distance between Great Vessels and the Lumbar Spine: MRI Study for Anterior Longitudinal Ligament Release Through a Lateral Approach

Marchi

Pimenta

Oliveira

et al. 2016

J Neurol Surg A Cent Eur Neurosurg

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Anterior column reconstruction using the lateral transpsoas approach requires sectioning of the anterior longitudinal ligament while protecting the great vessels. Our aim was to study the anatomical plane of separation between the retroperitoneal vessels and the anterior aspect of the lumbar spine as they relate to safety in the lateral transpsoas anterior column reconstruction procedure. A total of 100 T2-weighted magnetic resonance imaging (MRI) examinations were studied. Measurements were obtained for each vertebral body and for each intervertebral disk levels from L1-L2 to L4-L5, and for these vessels: abdominal aorta, inferior vena cava , and common iliac vessels. The following parameters were obtained: (sagittal) total lumbar lordosis and segmental lordosis; (axial) closest distance (areolar space [AS]) between the lumbar spine and vessels; and position of the great vessels. The AS was differently distributed for the abdominal aorta and the inferior vena cava. Average values for the inferior vena cava were larger at upper levels ( < 0.001; range: 0.2-9.2 mm), and there were differences between the arteries among the levels ( < 0.001; range: 1.0-4.3 mm) but with no clear difference between the upper and lower lumbar spine. A narrower AS was found at the intervertebral disk level compared with the adjacent vertebral body. At L4-L5, the veins usually lay over the anterior border of the lumbar spine, with substantially wider AS at other lumbar levels. The plane between the great vessels and the lumbar spine is differently distributed along the lumbar spine and is especially narrow at lower lumbar levels and in front of the intervertebral disk. The results shown here may help guide surgical decision making for the lateral anterior column reconstruction and may aggregate data from dislocation of the vessels in the lateral decubitus and individualized analysis.

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Anatomical Relationships of the Anterior Blood Vessels to the Lower Lumbar Intervertebral Discs

Cited by 38 publications

References 22 publications

Retroperitoneal oblique corridor to the L2–S1 intervertebral discs: an MRI study

Retroperitoneal oblique corridor to the L2–S1 intervertebral discs: an MRI study

Morphometric Analysis of Significant Vascular Structures in Posterior Disc Surgery in Computed Tomography Angiography

Distance between Great Vessels and the Lumbar Spine: MRI Study for Anterior Longitudinal Ligament Release Through a Lateral Approach

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