Singhatanadgige Weerasak, Kang Daniel G, Wiranuwat Dol, Tanavalee Chotetawan, Yingsakmongkol Wicharn, Limthongkul Worawat
1 Department of Orthopedic Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
2 Madigan Army Medical Center, Tacoma, Washington, USA.
J Orthop Surg (Hong Kong). 2018 Jan-Apr;26(1):2309499017754094. doi: 10.1177/2309499017754094.
To assess the anatomic path of the middle sacral artery (MSA) at the presacral area and its relationship to the spinal midline during an axial lumbar interbody fusion (AxiaLif) approach.
Fifty human cadavers (25 males, 25 females) were used in this study. A transabdominal approach was used to expose the anterior aspect of the L5/S1 intervertebral disc and the presacral space. We measured the size and distance from the spinal midline at the following positions: (a) middle of the L5/S1 disc level, (b) 1 cm below the sacral promontory (SP), and (c) 2 cm below the SP. Each parameter was measured three times by two observers, and the mean value analyzed.
The MSA was present and originated from the left common iliac artery in all cadavers with a mean width of 2.14 mm. The position of the MSA in relation to the midline was most commonly on the left side (LS, 56%) followed by the right side (RS, 34%) and midline (ML, 10%). In the LS group, the distance from the midline is relatively constant in the three measured positions with a mean value of (a) 1.78 mm (range, 0-8.17 mm), (b) 2.08 mm (range, 0-7.10 mm), and (c) 2.06 mm (range, 0-9.76 mm). In the RS group, the distance from the midline increased from cephalad to caudad, with a mean value of (a) 1.44 mm (range, 0-9.64 mm), (b) 2.19 mm (range, 0-9.95 mm), and (c) 2.92 mm (range, 0-10.03 mm).
Our study found the presacral anatomic path of the MSA was most commonly at the left of midline. In addition, the right-sided MSA variant had increasing distance from the midline along its anatomic path from cephalad to caudad. Our findings suggest an AxiaLif approach at the left of midline may place the MSA at greatest risk.
评估在轴向腰椎椎间融合术（AxiaLif）入路过程中，骶中动脉（MSA）在骶前区域的解剖路径及其与脊柱中线的关系。
本研究使用了50具人体尸体（25例男性，25例女性）。采用经腹入路暴露L5/S1椎间盘的前侧和骶前间隙。我们在以下位置测量了其大小和距脊柱中线的距离：（a）L5/S1椎间盘水平中点；（b）骶岬（SP）下方1 cm处；（c）SP下方2 cm处。每个参数由两名观察者测量三次，并分析平均值。
所有尸体中均存在MSA，其起源于左髂总动脉，平均宽度为2.14 mm。MSA相对于中线的位置最常见于左侧（LS，56%），其次是右侧（RS，34%）和中线（ML，10%）。在LS组中，在三个测量位置距中线的距离相对恒定，平均值分别为（a）1.78 mm（范围0 - 8.17 mm）、（b）2.08 mm（范围0 - 7.10 mm）和（c）2.06 mm（范围0 - 9.76 mm）。在RS组中，距中线的距离从头部向尾部增加，平均值分别为（a）1.44 mm（范围0 - 9.64 mm）、（b）2.19 mm（范围0 - 9.95 mm）和（c）2.92 mm（范围0 - 10.03 mm）。
我们的研究发现，MSA在骶前的解剖路径最常见于中线左侧。此外，右侧MSA变异体沿其解剖路径从头部向尾部距中线的距离增加。我们的研究结果表明，在中线左侧进行AxiaLif入路可能使MSA面临最大风险。
