Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
World Neurosurg. 2023 Jul;175:e775-e779. doi: 10.1016/j.wneu.2023.04.017. Epub 2023 Apr 8.
We sought to assess the lumbar sympathetic chain (LSC) relation to the surgical corridor for the oblique lumbar approach and the ability to mobilize the LSC.
Forty-three cadavers were included. A left-sided anterior retroperitoneal approach was performed in supine position. The distances between the great vessels and psoas muscle (oblique corridor) and distance between great vessels and LSC at the L2/3, L3/4, and L4/5 disk levels were measured. Mobilization of LSC at each disk level was done either close to or away from the psoas muscle, and each mobilization distance was measured.
The presence rates of LSC in oblique corridor were 19.5%, 43%, and 75.7% at L2/3, L3/4, and L4/5 levels, respectively. At the L2/3 disk level, the mean distance between the psoas muscle and LSC and its mobility were 0.61 mm ± 1.31 mm and 2.72 mm ± 1.24 mm, respectively. At the L3/4 disk level, the mean distance between the psoas muscle and LSC and its mobility were 1.72 mm ± 2.53 mm and 3.11 mm ± 1.02 mm, respectively. At the L4/5 disk level, the mean distance between the psoas muscle and LSC and its mobility were 2.94 mm ± 3.52 mm and 2.53 mm ± 1.03 mm, respectively. The mean width of corridor of L2/3, L3/4, and L4/5 were 10.73 mm ± 5.82 mm, 12.63 mm ± 5.02 mm, and 15.43 mm ± 6.31 mm, respectively.
The LSC tract usually lies in the oblique corridor in L4/5 but keeps decreasing in prevalence when approaching L3/4 and L2/3 levels. It can be mobilized a few millimeters close to or away from the psoas muscle. Care should be taken to prevent an LSC injury, particularly when the LSC needs to be retracted along with the psoas muscle.
评估斜侧腰椎入路手术通道与腰交感干（LSC）的关系，以及移动 LSC 的能力。
纳入 43 具尸体。采用仰卧位左侧腹膜后入路。测量大血管与腰大肌之间的距离（斜行通道）以及 L2/3、L3/4 和 L4/5 椎间盘水平的大血管与 LSC 之间的距离。在每个椎间盘水平，LSC 要么靠近腰大肌，要么远离腰大肌进行移动，并测量每次移动的距离。
LSC 在斜行通道中的存在率分别为 L2/3 水平 19.5%、L3/4 水平 43%和 L4/5 水平 75.7%。在 L2/3 椎间盘水平，腰大肌与 LSC 之间的平均距离及其可移动性分别为 0.61mm±1.31mm 和 2.72mm±1.24mm。在 L3/4 椎间盘水平，腰大肌与 LSC 之间的平均距离及其可移动性分别为 1.72mm±2.53mm 和 3.11mm±1.02mm。在 L4/5 椎间盘水平，腰大肌与 LSC 之间的平均距离及其可移动性分别为 2.94mm±3.52mm 和 2.53mm±1.03mm。L2/3、L3/4 和 L4/5 的通道平均宽度分别为 10.73mm±5.82mm、12.63mm±5.02mm 和 15.43mm±6.31mm。
LSC 束通常位于 L4/5 的斜行通道中，但在接近 L3/4 和 L2/3 水平时，其发生率逐渐降低。它可以在靠近或远离腰大肌几毫米的范围内移动。在需要将 LSC 与腰大肌一起牵拉时，应注意防止 LSC 损伤。
