Hirase Takashi, Shin Caleb, Thirumavalavan Jeyvikram, Boddapati Venkat, Lee Tiffany, Haghshenas Varan, Marco Rex Aw
Department of Orthopedic and Sports Medicine, Houston Methodist Orthopedic and Sports Medicine, Houston, TX, USA.
Department of Orthopaedic Surgery, New York-Presbyterian/Columbia UniversityIrving Medical Center, New York, NY, USA.
Global Spine J. 2024 Sep;14(7):1959-1967. doi: 10.1177/21925682231161577. Epub 2023 Feb 28.
Cross-sectional radioanatomic study.
To determine the feasibility of performing an anterior column realignment (ACR) using an anterior-to-psoas (ATP) approach at L1-L5.
Axial magnetic resonance images (MRI) of the L1-L5 disc levels obtained at a single institution were obtained and analyzed. The feasibility of performing an ACR was assessed using a combination of the size of the left oblique corridor (OC), the psoas morphology using the modified Moro classification, and the anterior disc edge to great vessel distance.
Three hundred MRI studies obtained from 300 patients were included. All patients had a measurable left OC at the L1-L4 levels. Twenty patients (6.7%) had no measurable OC at the L4-L5 level. According to the modified Moro's classification, a high-rising psoas was seen in 4 patients (1.3%) at the L3-L4 level and 57 patients (19.0%) at the L4-L5 level. An ALL release was considered high risk due to no measurable space between the anterior disc edge and the great vessels in 54 patients (18.0%) at the L1-L2 level, 39 patients (13.0%) at the L2-L3 level, 119 patients (39.7%) at the L3-L4 level, and 226 patients (75.3%) at the L4-L5 level.
ACR using an ATP approach is the most radioanatomically feasible at L2-L3. The L4-L5 level has the highest risk with regards to both the ATP approach and the ALL release for an ACR due to high rates of unmeasurable left OC and space between the anterior disc edge and the great vessels.
横断面放射解剖学研究。
确定在L1-L5节段采用腰大肌前入路（ATP）进行前柱复位（ACR）的可行性。
获取并分析在单一机构获得的L1-L5椎间盘水平的轴向磁共振成像（MRI）。采用左斜行通道（OC）大小、改良的莫罗分类法评估的腰大肌形态以及椎间盘前缘至大血管距离相结合的方法，评估进行ACR的可行性。
纳入了从300例患者获得的300份MRI研究。所有患者在L1-L4节段均有可测量的左侧OC。20例患者（6.7%）在L4-L5节段无可测量的OC。根据改良的莫罗分类法，在L3-L4节段有4例患者（1.3%）出现高位腰大肌，在L4-L5节段有57例患者（19.0%）出现高位腰大肌。由于在L1-L2节段有54例患者（18.0%）、L2-L3节段有39例患者（13.0%）、L3-L4节段有119例患者（39.7%）以及L4-L5节段有226例患者（75.3%）的椎间盘前缘与大血管之间无可测量的间隙，因此认为前纵韧带松解具有高风险。
采用ATP入路进行ACR在L2-L3节段在放射解剖学上最可行。由于不可测量的左侧OC以及椎间盘前缘与大血管之间间隙的发生率较高，L4-L5节段对于ATP入路和ACR的前纵韧带松解而言风险最高。
