Department of Neurosurgery and Spine Surgery, Claude Bernard University of Lyon 1, and Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France.
World Neurosurg. 2013 May-Jun;79(5-6):784-91. doi: 10.1016/j.wneu.2012.03.019. Epub 2012 Apr 2.
To report an in vivo anatomic evaluation of prevertebral vessels in the lumbar spine using three-dimensional (3D) computed tomography (CT) angiography and to develop the concept of vascular window for surgical access to L4-5 and L5-S1 disks.
In 146 patients who were scheduled for anterior lumbar spine surgery, 3D CT angiography was performed preoperatively. Spinal disorders included degenerative disk disease (n = 120) and low-grade spondylolisthesis (n = 26). 3D reconstructions were obtained using the volume-rendering technique. Level of aortic bifurcation and iliocavum confluence, presence of the ascending iliolumbar vein, presence of the central sacral vessels, and anatomic variations were analyzed. A vascular window at L5-S1 was defined as the "free vascular" area for the anterior part of the L5-S1 disk. A vascular window at L4-L5 was defined as the "free vascular" area for the left anterolateral part of the L4-5 disk.
The level of aortic bifurcation was most often observed at L4 (64%). The iliocavum confluence occurred most frequently at L5 (44%). The iliolumbar ascending vein and central sacral vessels were identified in 84% and 72% of cases. Five (3.5%) anatomic variations were noted: right internal iliac vein draining into the left common iliac vein in two cases and tortuous vessels in three cases. A vascular window was measured to 34.5 mm ± 12 at L5-S1 and to 23 mm ± 8 at L4-L5. The vascular window was <25 mm in approximately one in four patients at L5-S1 and in approximately two in three patients at L4-L5.
This study confirms that vascular anatomy in the lumbar spine is characterized by a great variability that has significance for preoperative assessment. 3D CT angiography allowed for an effective evaluation of the relationships between the prevertebral vessels and the intervertebral disks at L4-L5 and L5-S1. Although adherence of vessels to the anterior ligament cannot be predicted by this technique, the concept of vascular windows investigated preoperatively by CT angiography could be helpful in predicting the need for vessel mobilization during anterior lumbar spine surgery.
使用三维（3D）计算机断层血管造影术（CTA）报告腰椎前椎体血管的体内解剖评估，并为 L4-5 和 L5-S1 椎间盘的手术入路开发血管窗的概念。
在 146 名计划行前路腰椎手术的患者中，术前进行了 3D CTA 检查。脊柱疾病包括退行性椎间盘疾病（n=120）和低度脊椎滑脱（n=26）。使用容积再现技术获得 3D 重建。分析主动脉分叉和髂腔汇合水平、升主髂静脉的存在、中央骶血管的存在以及解剖变异。在 L5-S1 定义了一个血管窗，即 L5-S1 椎间盘前部分的“自由血管”区域。在 L4-L5 定义了一个血管窗，即 L4-5 椎间盘左前外侧部分的“自由血管”区域。
主动脉分叉的水平最常见于 L4（64%）。髂腔汇合最常见于 L5（44%）。84%和 72%的病例中发现了升主髂静脉和中央骶血管。注意到 5 种（3.5%）解剖变异：2 例右侧髂内静脉汇入左侧髂总静脉，3 例血管迂曲。在 L5-S1 处测量到血管窗为 34.5mm±12，在 L4-L5 处测量到血管窗为 23mm±8。在 L5-S1 处，约四分之一的患者血管窗<25mm，在 L4-L5 处，约三分之二的患者血管窗<25mm。
本研究证实，腰椎的血管解剖结构具有很大的变异性，这对术前评估具有重要意义。3D CTA 允许有效评估 L4-L5 和 L5-S1 椎间前椎体血管与椎间盘之间的关系。尽管该技术不能预测血管与前韧带的附着，但通过 CT 血管造影术术前研究的血管窗概念可能有助于预测前路腰椎手术中血管的移动需求。
