Boston Medical Center, Boston, MA.
Boston University School of Medicine, Boston University, Boston, MA.
Spine (Phila Pa 1976). 2022 Aug 1;47(15):1084-1092. doi: 10.1097/BRS.0000000000004360. Epub 2022 Jul 13.
Retrospective review of prospectively collected data.
To investigate the size of prepsoas surgical corridors, developed between the iliopsoas and prespinal vessels, at all disk levels between L1 and S1 granted by left and right lateral antepsoas (ATP) approaches. Secondary aims include evaluation of presurgery radiographic prepsoas windows between L1 and S1 with respect to the intraoperative findings.
The ATP technique is an evolving alternative to the transpsoas and direct anterior exposures for lumbar fusion. However, the vascular morphometric data of the ATP approach remain underexplored, especially at L5-S1.
Patients indicated for ATP lumbar-lumbosacral fusion between September 2018 and February 2020 were enrolled (n=121). Data were collected prospectively, including the following (in mm): intraoperative manual measurements of the premobilization psoas-vessel (pre-PV) window, the final postmobilization psoas-vessel (post-PV) window, and the preoperative radiographic psoas-to-vessel distance at the respective studied disk levels.
A total of 121 patients (75 female, mean age: 55.3 yr, 81.8% right-sided approach) underwent a total of 279 levels of spinal fusion. Irrespective of the ATP access laterality, we noted ample postmobilization psoas-vessel (post-PV differential) corridors: largest at L4-L5 (36-38 mm) followed by L5-S1 (31-35 mm), L3-L4 (32-33 mm), L2-L3 (28-30 mm), and L1-L2 (20-24 mm). Similarly, the relative increases of the psoas-vessel corridors (post-PV and pre-PV differentials, averaged: 31 mm at L5-S1, 32 mm at L4-L5, 26 mm at L3-L4, 25 mm at L2-L3, and 14 mm at L1-L2) were also significant in both lateral approaches. In right flank approaches, the right vascular structures projected more dorsally compared with left-sided vasculature ( P <0.05).
The ATP access offers generous bilateral prepsoas surgical windows to L1-S1 intervertebral disks, allowing for a safe anterior column release, decompression, instrumentation, and fusion.
前瞻性收集数据的回顾性研究。
研究左、右侧前路经腹直肌前方（ATP）入路在 L1 至 S1 所有节段的髂腰肌与脊柱前血管之间形成的前方肌间隙的大小。次要目的包括评估术前 L1 至 S1 段的脊柱前肌间隙与术中所见的相关性。
ATP 技术是腰椎融合术经椎间孔和直接前路入路的一种新兴替代方法。然而，ATP 入路的血管形态计量数据仍未得到充分探索，尤其是在 L5-S1 节段。
2018 年 9 月至 2020 年 2 月期间，我们对拟行 ATP 腰椎-腰骶段融合术的患者进行了前瞻性研究（n=121）。前瞻性收集以下数据（以毫米为单位）：术中预游离时髂腰肌-血管（pre-PV）窗的手动测量值、最终游离后髂腰肌-血管（post-PV）窗的手动测量值以及术前相应研究节段的脊柱前髂腰肌-血管距离。
共有 121 例患者（75 例女性，平均年龄 55.3 岁，81.8%为右侧入路）接受了 279 个节段的脊柱融合术。无论 ATP 入路的侧别如何，我们都发现了较大的游离后髂腰肌-血管（post-PV 差值）间隙：L4-L5 最大（36-38mm），其次是 L5-S1（31-35mm）、L3-L4（32-33mm）、L2-L3（28-30mm）和 L1-L2（20-24mm）。同样，在两种侧方入路中，髂腰肌-血管间隙的相对增加（post-PV 和 pre-PV 差值，平均：L5-S1 为 31mm，L4-L5 为 32mm，L3-L4 为 26mm，L2-L3 为 25mm，L1-L2 为 14mm）也很显著。在右侧入路中，右侧血管结构比左侧更向背侧突出（P<0.05）。
ATP 入路为 L1-S1 椎间盘提供了宽阔的双侧前方肌间隙，可安全进行前方柱松解、减压、内固定和融合。
