School of Medicine, Loma Linda University, Loma Linda, California, USA.
Twin Cities Spine Center, Minneapolis, Minnesota, USA.
Oper Neurosurg (Hagerstown). 2023 Jul 1;25(1):52-58. doi: 10.1227/ons.0000000000000696. Epub 2023 May 5.
Spinal fusion through the anterior-to-psoas (ATP) technique harbors several approach-related risks. We used abdominal computed tomography imaging to analyze the L1-L5 ATP fusion approach measurements, feasibility, degree of obstruction by non-neurological structures, and the influence of patient characteristics on ATP approach dimensions.
The vascular window, psoas window, safe window, and incision line anterior and posterior margins for the ATP approach were measured on abdominal computed tomography imaging. The feasibility of approach and the presence of kidneys, ribs, liver, spleen, and iliac crests within the ATP approach were also measured. Correlation and regression models among radiographic measurements and patient age, height, weight, and body mass index (BMI) were analyzed as well as differences in approach measurements based on sex.
Safe window and incision line measurements were more accommodating for the left-sided vs right-sided ATP approach. At L4-5, the ATP approach was not feasible 18% of the time on the left side vs 60% of the time on the right side. The spleen was present 22%, 10%, and 3% of the time from L1-4, while the liver was present 56%, 30%, and 9% of the time. The iliac crests were not observed within ATP parameters. Patient age, height, weight, and BMI did not strongly correlate with approach measurements, although ATP dimensions did differ based on sex.
This study reports characteristics of the ATP approach including approach measurements, feasibility, non-neurological structures at risk, and influencing factors to approach measurements. While incision line measurements are larger for male patients compared with female patients at the lower lumbar levels, safe window sizes are similar across all levels L1-L5. The kidneys, ribs, spleen, and liver are potential at-risk structures during the ATP approach, although the iliac crests pose limited concern for ATP technique. Patient characteristics such as age, height, weight, and BMI do not markedly affect ATP approach considerations.
经前路至腰大肌（ATP）技术的脊柱融合术存在多种与入路相关的风险。我们使用腹部计算机断层成像（CT）分析 L1-L5ATP 融合入路测量值、可行性、非神经结构的阻塞程度，以及患者特征对 ATP 入路尺寸的影响。
在腹部 CT 成像上测量 ATP 入路的血管窗、腰大肌窗、安全窗和切口线的前后缘。还测量了入路的可行性以及在 ATP 入路内存在的肾脏、肋骨、肝脏、脾脏和髂嵴。分析了影像学测量值与患者年龄、身高、体重和体重指数（BMI）之间的相关性和回归模型，以及基于性别的入路测量值差异。
安全窗和切口线测量值更适合左侧 vs 右侧 ATP 入路。在 L4-5 水平，左侧 ATP 入路不可行的情况占 18%，而右侧则占 60%。脾脏存在于 L1-4 的时间分别为 22%、10%和 3%，而肝脏存在于 L1-4 的时间分别为 56%、30%和 9%。髂嵴不在 ATP 参数范围内。尽管 ATP 尺寸确实因性别而异，但患者年龄、身高、体重和 BMI 与入路测量值相关性不强。
本研究报告了 ATP 入路的特点，包括入路测量值、可行性、有风险的非神经结构以及对入路测量值的影响因素。虽然男性患者的切口线测量值在较低腰椎水平大于女性患者，但在所有 L1-L5 水平上安全窗大小相似。在 ATP 入路过程中，肾脏、肋骨、脾脏和肝脏是潜在的危险结构，尽管髂嵴对 ATP 技术的影响有限。患者特征，如年龄、身高、体重和 BMI，不会显著影响 ATP 入路的考虑因素。
