Abstract
Purpose
The minimally invasive (MI) lateral lumbar interbody fusion (LLIF) approach has become increasingly popular for the treatment of degenerative lumbar spine disease. The neural anatomy of the lumbar plexus has been studied; however, the pertinent surgical vascular anatomy has not been examined in detail. The goal of this study is to examine the vascular structures that are relevant in relation to the MI-LLIF approach.
Methods
Anatomic dissection of the lumbar spines and associated vasculature was performed in three embalmed, adult cadavers. Right and left surgeon perspective views during LLIF were for a total of six approaches. During the dissection, all vascular elements were noted and photographed, and anatomical relationships to the vertebral bodies and disc spaces were analyzed. In addition, several axial and sagittal MRI images of the lumbar spine were analyzed to complement the cadaveric analysis.
Results
The aorta descends along the left anterior aspect of lumbar vertebra with an average distance of 2.1 cm (range 1.9–2.3 cm) to the center of each intervertebral disc. The vena cava descends along the right anterior aspect of lumbar vertebrates with average distance of 1.4 cm (range 1.3–1.6 cm) to the center of the intervertebral disc. Each vertebral body has two lumbar arteries (direct branches from the aorta); one exits to the left and one to the right side of the vertebral body. The lumbar arteries pass underneath the sympathetic trunk, run in the superior margin of the vertebral body and extend all the way across it, with average length of 3.8 cm (range 2.5–5 cm). The mean distance between the arteries and the inferior plate of the superior disc space is 4.2 mm (range 2–5 mm) and mean distance of 3.1 cm (range 2.8–3.8 cm) between two arteries in adjacent vertebrae. One of the cadavers had an expected normal anatomical variation where the left arteries at L3–L4 anastomosed dorsally of the vertebral bodies at the middle of the intervertebral disc.
Conclusions
Understanding the vascular anatomy of the lateral and anterior lumbar spine is paramount for successfully and safely executing the LLIF procedure. It is imperative to identify anatomical variations in lumbar arteries and veins with careful assessment of the preoperative imaging.
Similar content being viewed by others
References
Ozgur BM, Aryan HE, Pimenta L, Taylor WR (2006) Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6(4):435–443. doi:10.1016/j.spinee.2005.08.012
Anand N, Baron EM, Thaiyananthan G, Khalsa K, Goldstein TB (2008) Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis: a technique and feasibility study. J Spinal Disord Tech 21(7):459–467. doi:10.1097/BSD.0b013e318167b06b
Dakwar E, Cardona RF, Smith DA, Uribe JS (2010) Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus 28(3):E8. doi:10.3171/2010.1.focus09282
Rodgers WB, Cox C, Gerber E (2007) Experience and early results with a minimally invasive technique for anterior column support through extreme lateral interbody fusion (XLIF®). US Musculoskelet Rev 2(1):28–32
Rodgers W, Cox C, Gerber E (2009) Minimally invasive treatment (XLIF) of adjacent segment disease after prior lumbar fusions. Int J Minim Invasive Spinal Technol 3(4):47
Oliveira L, Marchi L, Coutinho E, Pimenta L (2010) A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine (Phila Pa 1976) 35(26 Suppl):S331–S337. doi:10.1097/BRS.0b013e3182022db0
Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH (2007) Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine (Phila Pa 1976) 32(20):2238–2244. doi:10.1097/BRS.0b013e31814cf24a
Sofianos DA, Briseno MR, Abrams J, Patel AA (2012) Complications of the lateral transpsoas approach for lumbar interbody arthrodesis: a case series and literature review. Clin Orthop Relat Res 470(6):1621–1632. doi:10.1007/s11999-011-2088-3
Santillan A, Patsalides A, Gobin YP (2010) Endovascular embolization of iatrogenic lumbar artery pseudoaneurysm following extreme lateral interbody fusion (XLIF). Vasc Endovascular Surg 44(7):601–603. doi:10.1177/1538574410374655
Assina R, Majmundar NJ, Herschman Y, Heary RF (2014) First report of major vascular injury due to lateral transpsoas approach leading to fatality. J Neurosurg Spine 21(5):794–798. doi:10.3171/2014.7.spine131146
Arnold PM, Anderson KK, McGuire RA Jr (2012) The lateral transpsoas approach to the lumbar and thoracic spine: a review. Surg Neurol Int 3(Suppl 3):S198–S215. doi:10.4103/2152-7806.98583
Uribe JS, Arredondo N, Dakwar E, Vale FL (2010) Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study. J Neurosurg Spine 13(2):260–266. doi:10.3171/2010.3.spine09766
Bina RW, Zoccali C, Skoch J, Baaj AA (2015) Surgical anatomy of the minimally invasive lateral lumbar approach. J Clin Neurosci 22(3):456–459. doi:10.1016/j.jocn.2014.08.011
Graham RB, Wong AP, Liu JC (2014) Minimally invasive lateral transpsoas approach to the lumbar spine: pitfalls and complication avoidance. Neurosurg Clin N Am 25(2):219–231. doi:10.1016/j.nec.2013.12.002
Acosta FL Jr, Drazin D, Liu JC (2013) Supra-psoas shallow docking in lateral interbody fusion. Neurosurgery 73(1 Suppl Operative):ons48–ons51. doi:10.1227/NEU.0b013e318288a202 (discussion ons52)
Hu WK, He SS, Zhang SC, Liu YB, Li M, Hou TS, Ma XL, Wang J (2011) An MRI study of psoas major and abdominal large vessels with respect to the X/DLIF approach. Eur Spine J 20(4):557–562. doi:10.1007/s00586-010-1609-1
Williams PL (1995) Gray’s anatomy: the anatomical basis of medicine and surgery, 38th edn. Churchill Livingstone, London
Baniel J, Foster RS, Donohue JP (1995) Surgical anatomy of the lumbar vessels: implications for retroperitoneal surgery. J Urol 153(5):1422–1425
Lolis E, Panagouli E, Venieratos D (2011) Study of the ascending lumbar and iliolumbar veins: surgical anatomy, clinical implications and review of the literature. Ann Anat 193(6):516–529. doi:10.1016/j.aanat.2011.09.004
Karunanayake AL, Pathmeswaran A (2013) Anatomical variations of lumbar arteries and their clinical implications: a cadaveric study. ISRN Anat. doi:10.5402/2013/154625
Delasotta LA, Radcliff K, Sonagli MA, Miller L (2012) Aberrant iliac artery: far lateral lumbosacral surgical anatomy. Orthopedics 35(2):e294–e297. doi:10.3928/01477447-20120123-28
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
Alkadhim, M., Zoccali, C., Abbasifard, S. et al. The surgical vascular anatomy of the minimally invasive lateral lumbar interbody approach: a cadaveric and radiographic analysis. Eur Spine J 24 (Suppl 7), 906–911 (2015). https://doi.org/10.1007/s00586-015-4267-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-015-4267-5