Inamasu J, Kim D H, Logan L
Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA.
Minim Invasive Neurosurg. 2005 Jun;48(3):127-31. doi: 10.1055/s-2004-830262.
A recent accumulation of surgical and radiological literature has helped spine surgeons to better understand the anatomy and establish surgical trajectories to the anterior L4-L5 disc space. However, the preoperative display of anatomic data in individual subjects in the three-dimensional (3-D) mode has rarely been attempted. The objective of this study was to acquire 3-D images of the abdominal great vessels pertinent to the L4-L5 anterior lumbar interbody fusion (ALIF), and to better define the radiological vascular anatomy. The 3-D images of 100 subjects with non-spinal diseases, generated from abdominal computed tomography angiography (CTA), were analyzed retrospectively. The anatomy of the great vessels pertinent to the L4-L5 ALIF procedure was investigated by measuring the level of the abdominal aorta (AA) bifurcation and that of the inferior vena cava (IVC) confluence in relation to the lumbar vertebral body. These two complexes were segmented into upper or lower parts, or disc level. The visibility of the middle sacral artery (MSA) and the left L4 lumbar artery on the 3-D images was also assessed. The AA bifurcation level was above L4 in 4, at L4 in 55, at L4-L5 in 23, and at L5 in 18 subjects. The IVC confluence level was at L4 in 17, at L4-L5 in 14, at L5 in 68 and below L5 in 1 subject. Levels of the bifurcation of the AA/IVC as combined data showed that the AA bifurcation was usually located 1 - 2 segments above the IVC confluence. The MSA and L4 segmental artery were identified in 79 and 83 subjects, respectively. The 3-D images of the abdominal great vessels together with the lumbar spinal column were reliably depicted. Anatomic data obtained from this study are in accordance with those obtained from conventional 2-D studies, and the 3-D images can serve as a versatile tool for preoperative evaluation for the ALIF candidates and can contribute to the reduction of surgical time and perioperative vascular complications.
近期外科和放射学文献的积累，有助于脊柱外科医生更好地了解解剖结构，并确定通往L4-L5椎间盘前间隙的手术路径。然而，很少有人尝试以三维（3-D）模式在个体受试者中术前展示解剖数据。本研究的目的是获取与L4-L5前路腰椎椎间融合术（ALIF）相关的腹部大血管的3-D图像，并更好地界定放射学血管解剖结构。对100例患有非脊柱疾病的受试者通过腹部计算机断层血管造影（CTA）生成的3-D图像进行回顾性分析。通过测量腹主动脉（AA）分叉水平以及下腔静脉（IVC）汇合水平与腰椎椎体的关系，研究与L4-L5 ALIF手术相关的大血管解剖结构。这两个复合体被分为上部或下部，或椎间盘水平。还评估了3-D图像上骶中动脉（MSA）和左L4腰动脉的可视性。AA分叉水平在L4以上的有4例，在L4的有55例，在L4-L5的有23例，在L5的有18例。IVC汇合水平在L4的有17例，在L4-L5的有14例，在L5的有68例，在L5以下的有1例。AA/IVC联合数据的分叉水平显示，AA分叉通常位于IVC汇合上方1-2个节段。分别在79例和83例受试者中识别出MSA和L4节段动脉。可靠地描绘了腹部大血管与腰椎柱的3-D图像。本研究获得的解剖数据与传统二维研究获得的数据一致，3-D图像可作为ALIF候选者术前评估的通用工具，并有助于减少手术时间和围手术期血管并发症。
