Marchi Luis, Pimenta Luiz, Oliveira Leonardo, Fortti Fernanda, Amaral Rodrigo, Abdala Nitamar
Department of Minimally Invasive Surgery, Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil.
Department of Imaging Diagnosis, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
J Neurol Surg A Cent Eur Neurosurg. 2017 Mar;78(2):144-153. doi: 10.1055/s-0036-1592144. Epub 2016 Sep 21.
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.
采用经腰大肌外侧入路进行前柱重建时，需要切断前纵韧带，同时保护大血管。我们的目的是研究腹膜后血管与腰椎前方之间的解剖分离平面，因为它们与经腰大肌外侧前柱重建手术的安全性相关。共研究了100例T2加权磁共振成像（MRI）检查。对每个椎体以及从L1-L2至L4-L5的每个椎间盘水平进行测量，并对以下血管进行测量：腹主动脉、下腔静脉和髂总血管。获得了以下参数：（矢状面）腰椎总前凸和节段性前凸；（横断面）腰椎与血管之间的最短距离（乳晕间隙[AS]）；以及大血管的位置。腹主动脉和下腔静脉的AS分布不同。下腔静脉的平均值在上部水平较大（<0.001；范围：0.2-9.2mm），各水平动脉之间存在差异（<0.001；范围：1.0-4.3mm），但腰椎上下部之间无明显差异。与相邻椎体相比，椎间盘水平的AS较窄。在L4-L5水平，静脉通常位于腰椎前缘上方，在其他腰椎水平AS明显更宽。大血管与腰椎之间的平面沿腰椎分布不同，在腰椎下部水平和椎间盘前方尤其狭窄。此处所示结果可能有助于指导外侧前柱重建的手术决策，并可能汇总侧卧位时血管移位的数据并进行个体化分析。
