Relationship of the lumbar lordosis angle to the abdominal aortic bifurcation and inferior vena cava confluence levels

Moussallem, Charbel D.; Hamad, Ibrahim Abou; El-Yahchouchi, Christine; Moussallem, Maroun D.; Arnalsteen, Damien M.; Mertl, P.; Havet, É.

doi:10.1002/ca.22030

Cited by 14 publications

(13 citation statements)

References 100 publications

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“…Nevertheless, previous studies showed that CMLT was lower in female patients but this did not affect the TSLT and that age may influence the level of TSLT [9, 13]. Similar to this work, a recent study done by Moussallem et al [14], published in Clinical Anatomy , revealed that the variations of the LLA closely correlate with the position of the abdominal aortic bifurcation and inferior vena cava confluence level. As for the limitation of this study, all MRI scans were performed in a supine position which may alter the LLA and the data was gathered in a retrospective manner.…”

Section: Discussionsupporting

confidence: 85%

Relationship of the Lumbar Lordosis Angle to the Level of Termination of the Conus Medullaris and Thecal Sac

Moussallem¹,

Masri

El-Yahchouchi

et al. 2014

Anatomy Research International

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The level of termination of the conus medullaris (CM) and thecal sac (TS) is subject to variations. We try to correlate in this study these variations with the lumbar lordosis angle (LLA) using MRI scans. A retrospective study was conducted using available MRI scans of the lumbar spine. The CM level of termination (CMLT) and the TS level of termination (TSLT) were identified according to a vertebral level after dividing it into 3 parts. The LLA was also identified for each individual. Linear regression models were fitted to the data available on 141 individuals. Of these 70 were males and 71 were females. The most common site of CMLT was at the upper third of L1 (32.6%) and that of the TSLT was at the middle third of S2 (29.8%). The mean LLA was 46° (20°–81°). The most proximal CMLT was at the upper third of T12, whereas the most distal one was at the upper third of L2. The most proximal TSLT was at the upper third of S1, whereas the most distal one was at S3-S4 disc space. The CMLT showed a positive correlation with the LLA. In conclusion the CMLT and TSLT may be related to variations of the LLA.

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Section: Discussionsupporting

confidence: 85%

Relationship of the Lumbar Lordosis Angle to the Level of Termination of the Conus Medullaris and Thecal Sac

Moussallem¹,

Masri

El-Yahchouchi

et al. 2014

Anatomy Research International

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“…Meanwhile, the confluence of the common iliac veins was found between the superior third of the L-4 vertebral body and the inferior third of the L-5 vertebral body. The anatomy of the abdominal vessels and its relationship to the lumbar spine has been previously studied by Moussallem et al 26 using CT, and Pirró et al 30 using cadaveric dissection. A larger study by Chithriki et al in 2002, 10 using MRI, reported the aortic bifurcation between the superior third of the L-3 vertebral body and the middle third of the L-5 vertebral body, which is slightly higher compared with our study (i.e., inferior third of L-3).…”

mentioning

confidence: 99%

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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“…In a radiological study, MRI images of 134 patients with lower back pain were scanned, and LeIC was reported to vary according to age and sex (Capellades et al). Other studies reported the following: Pirró et al reported that LeIC of geriatric cases was located lower; Moussallem et al (2012) reported that the IVC was prolonged with age and that caused changing of the level of the IC; and Kornreich et al reported that this prolongation was more apparent in females. As specified in literature, it was concluded that both LeIC and LeAB of males were descended downwards due to old age, however, LeIC of females remained at the same level regardless of age, and LeAB of females was ascended first due to age and then was descended more apparently after the age of 60.…”

Section: Discussionmentioning

confidence: 98%

Morphometric Analysis of the Inferior Vena Cava Related to Lumbar Vertebra and the Aortic Bifurcation on Multidetector Computed Tomography (MDCT)

et al. 2016

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SALBACAK, A.; AKIN, D.; KABAKCI, A. D. A.; YILMAZ, M. T.; CICEKCIBASI, A. E. & OZBEK, O.Morphometric analysis of the inferior vena cava related to the lumbar vertebra and the aortic bifurcation on multidetector computed tomography (MDCT). Int. J. Morphol., 34(2):620-627, 2016. SUMMARY:Vascular structures are in greater danger during lumbar surgery. The purpose of this study is to describe the morphology of the inferior vena cava (IVC) related to the lumbar vertebra and aortic bifurcation (AB) and assessing the role of demographic values in these relations to decrease the risk of complications in the surgical interventions. The study was performed on Multidetector Computed Tomography (MDCT) images of 100 male and 100 female cases with an age range from 50 to 84 years. The morphometric values of the IVC obtained from the coronal, sagittal and the axial reformatted images were measured and compared with the demographic values. The distance from the IVC to the 1 st lumbar vertebra (L1) and 2 nd lumbar vertebra (L2) were measured as (26.5 mm and 18.1 mm) in males and (21.1 mm and 14.2 mm) in females with a high level of significance between genders; the distance from the IVC to the iliocaval confluence (IC), 3 rd lumbar vertebra (L3) and 4 rd lumbar vertebra (L4) were measured as (6.5 mm, 10.5 mm and 6.9 mm) in males and (4.9 mm, 9.1 mm and 5.5 mm) in females with significance between genders. The level of the IC was detected 46 % of males, 39 % of females at the level of lower third of L4. The vertical distance between the IC and the AB was measured and negative correlation between genders based on age was detected. Demographic values are important to consider the relationship of the IVC, the lumbar vertebra and the AB. The IVC was located further from the lumbar vertebra in males compared to females. Age increase played role in the approaching of the AB and the IC to each other in both gender and the IC to the promontory level in males.

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Relationship of the lumbar lordosis angle to the abdominal aortic bifurcation and inferior vena cava confluence levels

Cited by 14 publications

References 100 publications

Relationship of the Lumbar Lordosis Angle to the Level of Termination of the Conus Medullaris and Thecal Sac

Relationship of the Lumbar Lordosis Angle to the Level of Termination of the Conus Medullaris and Thecal Sac

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

Morphometric Analysis of the Inferior Vena Cava Related to Lumbar Vertebra and the Aortic Bifurcation on Multidetector Computed Tomography (MDCT)

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