Boghani Zain, Steele William Iii, Barber Sean M, Lee Jonathan J, Sokunbi Olumide, Blacklock J Bob, Trask Todd, Holman Paul
Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA.
Surg Neurol Int. 2020 Mar 28;11:54. doi: 10.25259/SNI_438_2019. eCollection 2020.
A minimally invasive approach to the L2-S1 disc spaces through a single, left-sided, retroperitoneal oblique corridor has been previously described. However, the size of this corridor varies, limiting access to the disc space in certain patients. Here, the authors retrospectively reviewed lumbar spine magnetic resonance imaging (MRI) in 300 patients to better define the size and variability of the retroperitoneal oblique corridor.
Lumbar spine MRI from 300 patients was reviewed. The size of the retroperitoneal oblique corridor from L2-S1 was measured. It was defined as the (1) distance between the medial aspect of the aorta and the lateral aspect of the psoas muscle from L2-L5 and (2) the distance between the midpoint of the L5-S1 disc and the medial aspect of the nearest major vessel on the left at L5-S1. In addition, the rostral-caudal location of the iliac bifurcation was measured.
The size of the retroperitoneal oblique corridor at L2/3, L3/4, L4/5, and L5/S1 was, respectively, 17.3 ± 6.4 mm, 16.2 ± 6.3 mm, 14.8 ± 7.8 cm, and 13.0 ± 8.3 mm. The incidence of corridor size <1 cm at L2/3, L3/4, L4/5, and L5/S1 was 10.3%, 16.0%, 30.0%, and 39.3%, respectively. The iliac bifurcation was most commonly found behind the L4 vertebral body ( = 158, 52.67%) followed by the L4/5 disc space ( = 74, 24.67%).
The size of the retroperitoneal oblique corridor diminishes in a rostral-caudal direction, often limiting access to the L4/5 and L5/S1 disc spaces.
此前已有通过单一左侧腹膜后斜行通道对L2 - S1椎间盘间隙进行微创治疗的方法描述。然而，该通道的大小存在差异，限制了某些患者对椎间盘间隙的进入。在此，作者回顾性分析了300例患者的腰椎磁共振成像（MRI），以更好地明确腹膜后斜行通道的大小和变异性。
回顾了300例患者的腰椎MRI。测量了L2 - S1的腹膜后斜行通道大小。其定义为：（1）L2 - L5水平主动脉内侧缘与腰大肌外侧缘之间的距离；（2）L5 - S1椎间盘中点与L5 - S1水平左侧最近主要血管内侧缘之间的距离。此外，还测量了髂总动脉分叉的头端 - 尾端位置。
L2/3、L3/4、L4/5和L5/S1水平的腹膜后斜行通道大小分别为17.3±6.4mm、16.2±6.3mm、14.8±7.8mm和13.0±8.3mm。L2/3、L3/4、L4/5和L5/S1水平通道大小<1cm的发生率分别为10.3%、16.0%、30.0%和39.3%。髂总动脉分叉最常见于L4椎体后方（n = 158，52.67%），其次是L4/5椎间盘间隙（n = 74，24.67%）。
腹膜后斜行通道的大小沿头端 - 尾端方向减小，常限制对L4/5和L5/S1椎间盘间隙的进入。
