Ko Myeong Jin, Park Seung Won, Wui Seong Hyun
Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea.
Neurospine. 2021 Dec;18(4):833-838. doi: 10.14245/ns.2142494.247. Epub 2021 Dec 31.
The injury to the common iliac vein (CIV) seems to be the most important concern during the anterior approach to the spine at L5-S1 level. We investigated the anatomy of the L5-S1 vertebral structures related to the CIV through a cadaveric study to find an anatomical clue for safe dissection of CIV.
Ten cadavers were prepared for this study. After removing the peritoneum and the presacral fascia, the section from the lower part of the L5 to the upper part of the S1 vertebral body was removed with the CIV attached. After decalcification, 2 sections in the vertical and horizontal directions were made for histological study.
An adipose tissue layer was present between the intervertebral disc and CIV. The adipose tissue layer in 6 cadavers was thin, and in 3 of these cadavers, the CIV was attached to the vertebral body and the disc. In the other 4 cadavers, the CIV was clearly separated from the vertebral body and the disc by the intervening adipose tissue layer (IATL). Under the microscope, a thin layer surrounding the anterior longitudinal ligament, periosteum, and disc was observed, and we named this structure the 'perivertebral membrane'. The perivertebral membrane was attached to the CIV when there was no IATL, but a potential space was detected under the membrane.
There was a thin membrane, perivertebral membrane, between the CIV and L5-S1 disc. In cases with CIV adhesion to the disc due to the absence of IATL, the CIV may be mobilized indirectly through the perivertebral membrane.
在L5 - S1水平行脊柱前路手术时，髂总静脉（CIV）损伤似乎是最为重要的关注点。我们通过尸体研究调查了与CIV相关的L5 - S1椎体结构的解剖情况，以寻找安全解剖CIV的解剖学线索。
为该研究准备了10具尸体。去除腹膜和骶前筋膜后，将附着有CIV的L5椎体下部至S1椎体上部的部分切除。脱钙后，制作垂直和水平方向的2个切片用于组织学研究。
椎间盘与CIV之间存在一层脂肪组织层。6具尸体中的脂肪组织层较薄，其中3具尸体中，CIV附着于椎体和椎间盘。在另外4具尸体中，CIV通过中间的脂肪组织层（IATL）与椎体和椎间盘明显分离。在显微镜下，观察到一层围绕前纵韧带、骨膜和椎间盘的薄层，我们将此结构命名为“椎周膜”。当不存在IATL时，椎周膜附着于CIV，但在膜下可检测到一个潜在间隙。
在CIV与L5 - S1椎间盘之间存在一层薄的膜，即椎周膜。在因缺乏IATL导致CIV与椎间盘粘连的情况下，可通过椎周膜间接游离CIV。
