Kang Byung-Uk, Lee Sang-Ho, Jeon Sang-Hyeop, Park Jong Dae, Maeng Dae Hyeon, Choi Young Geun, Tsang Yi-Sheng
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
J Neurosurg Spine. 2006 Dec;5(6):508-13. doi: 10.3171/spi.2006.5.6.508.
The complexity of the vascular anatomy pertinent to the L4-5 intervertebral disc space has led to difficulties when performing the anterior approach to the lumbar spine. The purpose of the present study was to evaluate the variations of the great vessels to match the imaging-documented axial anatomy with the surgical exposure.
The authors analyzed data obtained in 223 patients who had undergone mini-open anterior lumbar surgery involving the L4-5 disc. The preoperative magnetic resonance images or computed tomography scans were evaluated by examiners blinded to the surgical approach to determine the vascular configuration. All complications of the procedures were described. Two major variations of the vascular configuration were delineated according to the location of the bifurcation of the inferior vena cava. On images showing the lower margin of the L-4 vertebra, the anatomy in 182 patients (81%) was classified as Type A because the inferior vena cava (IVC) was not bifurcated; in 38 patients (17%) it was classified as Type B because the IVC was bifurcated. Type A could be subdivided into Types A1 and A2 according to whether the aorta was bifurcated (A2) or not (A1) on the same image. The surgical exposure used was above the bifurcations (in Type A) and below the bifurcations (in Type B). The major complications were three venous injuries, and the leading complication was sympathetic dysfunction in 14 patients, which in most cases resolved spontaneously.
Careful preoperative evaluation of the vascular anatomy is essential to conducting successful anterior lumbar surgery. The determination of an appropriate approach can contribute to a reduction of unnecessary vascular retraction and a consequent decrease in vascular complications.
与L4 - 5椎间盘间隙相关的血管解剖结构复杂，导致在进行腰椎前路手术时存在困难。本研究的目的是评估大血管的变异情况，以使影像学记录的轴向解剖结构与手术暴露相匹配。
作者分析了223例行涉及L4 - 5椎间盘的迷你开放式腰椎前路手术患者的数据。由对手术方式不知情的检查人员评估术前磁共振成像或计算机断层扫描，以确定血管形态。描述了手术的所有并发症。根据下腔静脉分叉的位置确定了两种主要的血管形态变异。在显示L4椎体下缘的图像上，182例患者（81%）的解剖结构被分类为A型，因为下腔静脉未分叉；38例患者（17%）被分类为B型，因为下腔静脉分叉。A型可根据同一图像上主动脉是否分叉（A2）再细分为A1和A2型。所采用的手术暴露在分叉上方（A型）和分叉下方（B型）。主要并发症为3例静脉损伤，主要并发症为14例患者出现交感神经功能障碍，大多数情况下可自发缓解。
术前仔细评估血管解剖结构对于成功进行腰椎前路手术至关重要。确定合适的手术入路有助于减少不必要的血管牵拉，从而降低血管并发症的发生。
