He Lei, Xie Peigen, Chen Ruiqiang, Shu Tao, Zhang Liangming, Feng Feng, Rong Limin
Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510635, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Nov 8;30(11):1412-1416. doi: 10.7507/1002-1892.20160291.
To analyze the relative position between lumbar plexus and access corridor of minimally invasive lateral transpsoas approach based on magnetic resonance imaging distribution of lumbar plexus by three dimensional reconstruction technique, so as to evaluate approach safety.
Three-dimensional fast imaging employing steady-state acquisition sequences of lumbar spine were performed on 71 patients with lumbar degenerative diseases between July 2012 and January 2015. The axial image distance between the anterior edge of lumbar plexus and sagittal central perpendicular line (SCPL) of disc was determined using the distance formula at the mid-disc space from L to L level. SCPL was drawn perpendicularly to the sagittal plane of intervertebral disc and it passed through its central point, which is initial dilator trajectory for transpsoas approach. With respect to the SCPL of disc, the distance with a positive value indicated neural tissue posterior to it whereas anterior to it represented by a negative value.
Various branches of lumbar plexus which passed through the psoas major anterior to the SCPL of disc were identified in 42 (59.2%), 58 (81.7%), and 70 (98.6%) patients at L, L, and L levels, respectively. It is possible to infer the presence of genitofemoral nerve in accordance with relevant anatomic research. A ventral migration of intrapsoas nerves is identified from L to L level. All differences between levels were statistically significant (<0.05).
With respect to the SCPL of disc, a pass way of guide wire or a radiographic reference landmark to place working channel, lumbar plexus lie posterior to it from L to L level and shift anteriorly to it at L level, while genitofemoral nerve locate anterior to the SCPL from L to L level. Neural retraction may take place during sequential dilation of working channel especially at L level.
基于磁共振成像通过三维重建技术分析腰大肌与微创外侧经腰大肌入路通道之间的相对位置，以评估入路安全性。
对2012年7月至2015年1月期间71例腰椎退行性疾病患者进行腰椎三维快速稳态采集序列成像。在椎间盘L至L节段的中间层面，使用距离公式确定腰丛前缘与椎间盘矢状中央垂线（SCPL）之间的轴向图像距离。SCPL垂直于椎间盘矢状面绘制并穿过其中心点，这是经腰大肌入路的初始扩张器轨迹。相对于椎间盘的SCPL，正值表示神经组织在其后，负值表示在其前。
分别在42例（59.2%）、58例（81.7%）和70例（98.6%）患者的L、L和L节段，识别出腰丛的各个分支在椎间盘SCPL前方穿过腰大肌。根据相关解剖学研究可以推断生殖股神经的存在。从L至L节段可发现腰大肌内神经向腹侧迁移。各节段之间的所有差异均具有统计学意义（<0.05）。
相对于椎间盘的SCPL，作为导丝的通道或放置工作通道的影像学参考标志，腰丛在L至L节段位于其后，在L节段向前移位，而生殖股神经在L至L节段位于SCPL前方。在工作通道的连续扩张过程中，尤其是在L节段，可能会发生神经牵拉。
