Pinho André R, Pereira Pedro A, Leite Maria João, Santos Cristina C, Vaz Ricardo P, Dulce Madeira M
Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.
Orthopedic and Traumatology Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal.
Int J Spine Surg. 2022 Jul 14;16(4):631-7. doi: 10.14444/8298.
Minimally invasive lateral lumbar interbody fusion is a technique that has become increasingly popular for the treatment of degenerative lumbar spine disease; however, the pertinent surgical vascular anatomy has not been examined in detail. The goal of this study is to examine the anatomy of the lower lumbar and median sacral arteries, which are important determinants of these surgical outcomes.
This is an observational, experimental study based on cadaveric models, including 20 embalmed adult human cadavers. The following measurements were made: length of the lumbar and median sacral arteries, vertical distance between the third and fourth lumbar arteries and the superior end plate of the corresponding vertebrae, anterior vertebral body height, and intervertebral disc height.
Our sample showcased considerable variability regarding vascular anatomy around the lower lumbar spine. In 10% of specimens, the abdominal aorta bifurcated at the level of the L3-L4 intervertebral disc, and 20% showed variations in vena cava origin. Regarding the lumbar arteries, in 10% of the sample, the fourth lumbar artery was absent on the right side, and 10% presented a fifth lumbar artery. The median sacral artery was present in all cadavers; however, in 15% of specimens, it originated from a common trunk that also gave rise to the fourth pair of lumbar arteries. Anterior vertebral body height was smaller in L3 comparing with L5 ( = 0.003), and there was a significant cephalocaudal increase in the anterior intervertebral disc height in the analyzed levels ( < 0.001). Bilaterally, the distance between the fourth lumbar arteries and the superior end plate of the L4 vertebral body was shorter than this distance at the L3 vertebral body ( < 0.001 and = 0.002 on the right and left, respectively).
These data may be useful in spine surgery planning and operative management. These anatomic variations should be identified beforehand to prevent difficulties during surgery and possible complications.
微创外侧腰椎椎间融合术是一种在治疗退行性腰椎疾病中越来越受欢迎的技术；然而，相关的手术血管解剖结构尚未得到详细研究。本研究的目的是检查下腰椎动脉和骶中动脉的解剖结构，它们是这些手术结果的重要决定因素。
这是一项基于尸体模型的观察性实验研究，包括20具防腐处理的成年人体尸体。进行了以下测量：腰动脉和骶中动脉的长度、第三和第四腰动脉与相应椎体上终板之间的垂直距离、椎体前缘高度和椎间盘高度。
我们的样本显示下腰椎周围血管解剖结构存在相当大的变异性。在10%的标本中，腹主动脉在L3-L4椎间盘水平分叉，20%显示腔静脉起源变异。关于腰动脉，在10%的样本中，右侧第四腰动脉缺如，10%出现第五腰动脉。所有尸体均存在骶中动脉；然而，在15%的标本中，它起源于一个共同的干，该干也发出第四对腰动脉。与L5相比，L3椎体前缘高度较小（ = 0.003），在所分析的节段中，椎间前缘高度存在显著的头尾向增加（ < 0.001）。双侧，第四腰动脉与L4椎体上终板之间的距离比L3椎体处的该距离短（右侧 < 0.001，左侧 = 0.002）。
这些数据可能有助于脊柱手术规划和手术管理。应预先识别这些解剖变异，以防止手术中出现困难和可能的并发症。
