Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), 1825 4th St., San Francisco, CA, 94158, USA.
Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA.
Spine Deform. 2021 Nov;9(6):1691-1698. doi: 10.1007/s43390-021-00363-x. Epub 2021 Jun 1.
To report a rare ureteral injury following anterior spinal fusion for adolescent idiopathic scoliosis (AIS) that resulted in complete nephrectomy and to delineate the anatomical relationship between the proximal ureter and the anterior lumbar spine based on CT angiography (CTA).
Thoracolumbar spine CTAs of children with AIS were reviewed. We measured the following relationships to the ureters: lateral-most aspect of vertebral body, anterior psoas at intervertebral disc/vertebral body levels, and lateral psoas at vertebral body level. Spine level at which the renal arteries originated from the aorta was identified. Distance from origin to corresponding vertebral body/intervertebral disc also was measured.
Forty-one girls and seven boys (mean age 12 years, range 7-18) were analyzed. Scoliosis lumbar convexity was left 94% and right 6%. From L1 to L4, ureter was identified within 1-2 cm of vertebral body. Distance between ureter and vertebral body and ureter and anterior psoas at intervertebral disc/vertebral body levels was less on left vs. right from L1 to L4 (p < 0.0001). Distance between ureter and lateral psoas was less on left vs. right from L1 to L2 (p = 0.0205; p = 0.0132) and greater on left vs. right from L3 to L4 (p = 0.0022; p = 0.0076). Renal artery originated at L1/L2 in > 50%. There was no difference in distance from renal artery origin to vertebral body/intervertebral disc (p = 0.4764).
Ureteral injury is a potentially morbid complication of anterior spine surgery. Injury can occur secondary to disrupted blood supply and mechanical tissue damage. Surgeons must clearly understand the juxta-spinal anatomy to limit dissection and modify retraction to reduce risk.
Level IV.
报告一例青少年特发性脊柱侧凸（AIS）前路脊柱融合术后罕见的输尿管损伤，导致完全肾切除，并根据 CT 血管造影（CTA）描绘近端输尿管与前腰椎脊柱的解剖关系。
回顾了 AIS 儿童的胸腰椎脊柱 CTA。我们测量了以下与输尿管的关系：椎体最外侧、椎间盘/椎体水平的腰大肌前侧和椎体水平的腰大肌外侧。确定肾动脉发自主动脉的脊柱水平。还测量了从起点到相应椎体/椎间盘的距离。
共分析了 41 名女孩和 7 名男孩（平均年龄 12 岁，范围 7-18 岁）。脊柱侧凸腰椎凸侧为左侧 94%，右侧 6%。从 L1 到 L4，输尿管位于椎体 1-2cm 范围内。从 L1 到 L4，左侧输尿管与椎体和椎间盘/椎体水平的输尿管与腰大肌前侧之间的距离小于右侧（p<0.0001）。从 L1 到 L2，左侧输尿管与腰大肌外侧之间的距离小于右侧（p=0.0205；p=0.0132），从 L3 到 L4 则大于右侧（p=0.0022；p=0.0076）。50%以上的肾动脉起源于 L1/L2。从肾动脉起源到椎体/椎间盘的距离没有差异（p=0.4764）。
输尿管损伤是前路脊柱手术潜在的严重并发症。损伤可能是由于血供中断和组织机械损伤引起的。外科医生必须清楚了解脊柱旁解剖结构，以限制解剖和修改牵开，以降低风险。
IV 级。
