Seattle Science Foundation, Seattle, Washington, USA.
Department of Anatomical Sciences, St. George's University, St. George's, Grenada.
World Neurosurg. 2019 Aug;128:e768-e772. doi: 10.1016/j.wneu.2019.04.252. Epub 2019 May 9.
Safe surgical approaches to the anterolateral lumbar spine require a good working knowledge of the anatomy and anatomic variations of this region. As the iliolumbar vein is in the vicinity of both oblique and lateral transpsoas approaches to the lower lumbar spine, the following study was performed to better elucidate its anatomy, variations, and position during such surgical procedures.
Fifteen (30 sides) fresh frozen adult cadavers underwent dissection of the iliolumbar vein (ILV). The origin, course, variants, relations, and morphometrics of each vein were documented. Fluoroscopy of the vessels was performed. Lastly, anterior oblique and lateral transpsoas approaches to the lumbar spine were carried out in order to evaluate for potential ILV injury.
An ILV was found on all but 2 sides (93.3%). It arose as a common trunk from the common iliac vein on 14 sides. Left ILVs tended to have a more distal origin than right ILVs. ILVs had a mean length of 3.7 cm and a mean width of 0.9 cm and were significantly larger on right versus left sides (P < 0.05). Left-sided ILVs tended to have more branches than right-sided veins. The majority of vertical branches of the ILV traveled anterior to the ventral rami of the lumbar spinal nerves, most commonly L4. The ILV and, in particular, its vertical branches coursed next to the L4 and L5 vertebrae.
The ILV should be considered during both oblique and lateral transpsoas approaches to the lumbar spine.
安全的腰椎前外侧入路需要对该区域的解剖结构和解剖变异有很好的了解。由于髂腰静脉位于腰椎下斜侧和侧方经椎间孔入路的附近，因此进行了以下研究以更好地阐明其解剖结构、变异和在这些手术过程中的位置。
15 具（30 侧）新鲜冷冻成人尸体进行了髂腰静脉（ILV）的解剖。记录了每条静脉的起源、走行、变异、关系和形态学。对血管进行透视检查。最后，进行了腰椎前斜侧和侧方经椎间孔入路，以评估潜在的 ILV 损伤。
除了 2 侧（93.3%）外，所有侧均发现有 ILV。14 侧从髂总静脉共同起源为共同干。左侧 ILV 的起源比右侧更偏下。ILV 的平均长度为 3.7 厘米，平均宽度为 0.9 厘米，右侧明显大于左侧（P<0.05）。左侧 ILV 比右侧有更多的分支。ILV 的大部分垂直分支在腰椎脊神经的腹侧支之前走行，最常见于 L4。ILV 及其垂直分支通常紧邻 L4 和 L5 椎体走行。
在腰椎下斜侧和侧方经椎间孔入路时应考虑 ILV。
