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

Abstract

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.

The Impact of Patient-Specific Positions on the Relationship between Iliac Blood Vessels and Lumbar Intervertebral Discs: Anatomical Significance and Clinical Implications

“…The mean distance of arteries at the level of L4-L5 was 4.3 mm in the supine and prone position [39]. A study by Marchi et al [40] showed the areolar space to be narrow in the supine position, especially in the lower lumbar segment. The same study also indicated that the areolar space could be maximized in the lateral patient position, while the average values of areolar space in relation to inferior vena cava were larger in the superior lumbar segment.…”

<p>Lateral Position versus Prone Position for Cervical Laminoplasty: A Retrospective Comparative Study</p>

“…The lateral decubitus position is generally used in spine surgery for transthoracic or thoracoabdominal lateral vertebral column access, although its usage in posterior cervical spine surgery is seldom reported. [4][5][6][7] In recent years, we have begun to use the lateral position in cervical laminoplasty in our hospital, we found that the lateral position has some advantages over the prone position. The lateral position facilitates surgical field drainage and intraspinal inspection (Figures 1 and 2).…”

Planificación basada en imágenes de resonancia magnética para la cirugía de columna de acceso lateral. ¿Es un procedimiento seguro? Estudio descriptivo de distribución de grandes vasos y psoas

“…Se registró también si la posición del psoas era demasiado anterior (signo de Mickey Mouse o the rising psoas). 16 Se utilizó el método Moro 17 que divide el espacio intervertebral en seis zonas que van de anterior a posterior (Figuras 1 y 2). El aspecto anterior del margen anterior del cuerpo vertebral fue definido como zona A; el aspecto posterior del margen posterior, como zona P; las zonas I, II, III, IV fueron distribuidas igualmente entre el margen anterior y el margen posterior, del anterior al posterior.…”

“…11 Sin embargo, la distribución de los vasos grandes abdominales y los músculos psoas principales de cada espacio intervertebral lumbar es inconsistente. [12][13][14][15] Hay pocas publicaciones que describen la anatomía usando imágenes por resonancia magnética (RM), 12,16 y la muestra es pequeña.…”