Segmental Arteries and Veins at Higher Lumbar Levels Can Intersect the Adjacent Caudal Intervertebral Disc in the Anterior Part of the Spinal Column : A Cadaveric Analysis

概要

Minimally invasive techniques for spinal surgery (MIS) have been developed to reduce tissue damage. MIS enables surgeons to approach the vertebral bodies and intervertebral discs (IVD) with minimal tissue injury and exposure, through the use of specially designed devices. However, the lateral transpsoas approach to the IVD is associated with the risk of segmental vessel injury. Previous studies have described the vascular anatomy on the lateral part of the vertebral body; however, there are no reports that describe the segmental vessels on its anterior aspect. Here, we report the important anatomical features of the segmental arteries and veins, that can intersect the anterior part of the IVD. We consider that these vessels are at risk of vascular injury when anterior retractors are placed during lateral lumbar interbody fusion (LLIF) or when cutting the anterior longitudinal ligament during anterior column realignment (ACR). Purpose of this study is to investigate the anatomical features of the segmental arteries and veins in the anterior part of the spinal column in order to prevent segmental vessel injury. Five formalin-embalmed human cadavers were used. We assessed the proportion of segmental arteries and veins that intersected the IVD in the L2 to L5 range, as well as their course on the anterior part of the spinal column. The segmental arteries and veins commonly intersect the anterior part of the IVD (artery: 28.1%, vein: 42.1%). Seven out of 10 (70%) segmental arteries at L2 intersected the IVD, but at L3 and L4, only one artery intersected the IVD. The proportion of segmental veins that intersected the IVD was 60%, 50%, and 16.7% at L2, L3, and L4, respectively. The segmental arteries and veins frequently intersect the IVD in the anterior part of the spinal column. Therefore, it is necessary to consider these individual anatomical features in order to prevent vascular damage during LLIF or ACR.