使用L1至S1腹部CT成像比较经腰大肌前方与经腰大肌手术入路时非神经结构的风险
Comparison of Nonneurological Structures at Risk During Anterior-to-Psoas Versus Transpsoas Surgical Approaches Using Abdominal CT Imaging From L1 to S1.
作者信息
Razzouk Jacob, Ramos Omar, Harianja Gideon, Carter Mei, Mehta Shaurya, Wycliffe Nathaniel, Danisa Olumide, Cheng Wayne
机构信息
School of Medicine, Loma Linda University, Loma Linda, CA, USA.
Twin Cities Spine Center, Minneapolis, MN, USA.
出版信息
Int J Spine Surg. 2023 Dec 26;17(6):809-815. doi: 10.14444/8542.
BACKGROUND
The kidneys, ribs, liver, spleen, and iliac crests can pose access-related issues to the disc space during both anterior-to-psoas (ATP) and transpsoas (TP) surgical approaches. The aim of this study was to identify and compare the presence and degree of obstruction caused by these structures for the ATP and TP approaches bilaterally from L1 to S1 using abdominal computed tomography.
METHODS
Presence of obstruction by a given structure was recorded if the structure was within ATP or TP borders. Degree of obstruction was calculated as the quotient of the structure measurement within the ATP or TP approach divided by the entire corridor length at the point of obstruction.
RESULTS
The percentage of time the left kidney was present during the ATP vs TP approaches at L1 to L2 was 44% vs 89% ( < 0.001), at L2 to L3 was 26% vs 75% ( < 0.001), and at L3 to L4 was 5% vs 19% ( < 0.001). For the right kidney, these values were 37% vs 78% ( < 0.001), 43% vs 71% ( < 0.001), and 11% vs 18% ( < 0.001). The percentage of time the left rib was present during ATP vs TP approaches was 41% vs 81% ( < 0.001) at L1 to L2 and 11% vs 26% ( = 0.413) at L2 to L3. With respect to the liver, the ATP approach was obstructed 56%, 30%, and 9% of the time at the levels of L1 to L2, L2 to L3, and L3 to L4; the liver was not present in L1 to L4 TP approach.
CONCLUSIONS
This study is the first to both characterize and compare nonneurological structures at risk during ATP and TP fusion approaches bilaterally from L1 to S1 using abdominal computed tomography. Findings suggest the ATP approach poses less structures at risk relative to the TP approach with respect to the kidneys, ribs, and iliac crests bilaterally. The TP approach offers advantages compared with ATP approach with respect to the liver and spleen.
CLINICAL RELEVANCE
Findings from this study are clinically relevant for ATP and TP surgical approach planning.
背景
在腰大肌前（ATP）和经腰大肌（TP）手术入路过程中，肾脏、肋骨、肝脏、脾脏和髂嵴可能给椎间盘间隙带来与入路相关的问题。本研究的目的是使用腹部计算机断层扫描，识别并比较从L1至S1双侧的ATP和TP入路中，这些结构造成阻塞的存在情况及程度。
方法
如果某个结构位于ATP或TP边界内，则记录该结构造成阻塞的情况。阻塞程度的计算方法为，ATP或TP入路内结构测量值除以阻塞点处的整个通道长度。
结果
在L1至L2节段，ATP入路与TP入路中左肾出现的时间百分比分别为44%和89%（<0.001）；在L2至L3节段分别为26%和75%（<0.001）；在L3至L4节段分别为5%和19%（<0.001）。对于右肾，这些值分别为37%和78%（<0.001）、43%和71%（<0.001）、11%和18%（<0.001）。在L1至L2节段，ATP入路与TP入路中左肋骨出现的时间百分比分别为41%和81%（<0.001）；在L2至L3节段分别为11%和26%（=0.413）。关于肝脏，在L1至L2、L2至L3和L3至L4节段，ATP入路受阻的时间分别为56%、30%和9%；在L1至L4的TP入路中未出现肝脏。
结论
本研究首次使用腹部计算机断层扫描，对从L1至S1双侧的ATP和TP融合入路过程中存在风险的非神经结构进行了特征描述和比较。研究结果表明，在双侧肾脏、肋骨和髂嵴方面，相对于TP入路，ATP入路涉及的风险结构较少。在肝脏和脾脏方面，TP入路相对于ATP入路具有优势。
临床意义
本研究结果对ATP和TP手术入路规划具有临床意义。
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