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Anatomical differences in patients with lumbosacral transitional vertebrae and implications for minimally invasive spine surgery


, : Anatomical differences in patients with lumbosacral transitional vertebrae and implications for minimally invasive spine surgery. Journal of Neurosurgery. Spine (): 1-7

NlmCategory="UNASSIGNED">OBJECTIVE The objective of this study was to investigate the neurovascular and anatomical differences in patients with lumbosacral transitional vertebrae (LSTV) and the associated risk of neurovascular injury in minimally invasive spine surgery. METHODS The authors performed a retrospective study of CT and MR images of the lumbar spine obtained at their institution between 2010 and 2014. The following characteristics were evaluated: level of the iliac crest in relation to the L4-5 disc space, union level of the iliac veins and arteries in relation to the L4-5 disc space, distribution of the iliac veins and inferior vena cava according to the different Moro zones (A, I, II, III, IV, P) at the L4-5 disc space, and the location of the psoas muscle at the L4-5 disc space. The findings were compared with findings on images obtained in 28 age- and sex-matched patients without LSTV who underwent imaging studies during the same time period. RESULTS Twenty-eight patients (12 male, 16 female) with LSTV and the required imaging studies were identified; 28 age- and sex-matched patients who had undergone CT and MRI studies of the thoracic and lumbar spine imaging but did not have LSTV were selected for comparison (control group). The mean ages of the patients in the LSTV group and the control group were 52 and 49 years, respectively. The iliac crest was located at a mean distance of 12 mm above the L4-5 disc space in the LSTV group and 4 mm below the L4-5 disc space in the controls. The iliac vein union was located at a mean distance of 8 mm above the L4-5 disc space in the LSTV group and 2.7 mm below the L4-5 disc space in the controls. The iliac artery bifurcation was located at a mean distance of 23 mm above the L4-5 disc space in the LSTV group and 11 mm below the L4-5 disc space in controls. In patients with LSTV, the distribution of iliac vein locations was as follows: Zone A, 7.1%; Zone I only, 78.6%; Zone I encroaching into Zone II, 7.1%; and Zone II only, 7.1%. In the control group, the distribution was as follows: Zone A only, 17.9%; Zone A encroaching into Zone I, 75%; and Zone I only, 7.1%. There were no iliac vessels in Zone II in the control group. The psoas muscle was found to be rising away laterally and anteriorly from the vertebral body more often in patients with LSTV, resulting in the iliac veins being found in the "safe zone" only 14% of the time, greatly increasing the risk of vascular injury. CONCLUSIONS In patients with LSTV, the iliac crest is more likely to be above the L4-5 disc space, which increases the technical challenges of a lateral approach. The location of the psoas muscle rising away laterally and ventrally in patients with LSTV compared with controls and with the union of the iliac veins occurring more often above the L4-5 disc space increases the risk for iatrogenic vascular injury at the L4-5 level in this patient population.

US$19.90

PMID: 27661564

DOI: 10.3171/2016.6.SPINE1691


Other references

I.V.S.emarova; S.M.K.rotkov; V.P.N.sterov, 2011: Effect of oxidative processes in mitochondria on contractility of heart muscle of the frog Rana temporaria Actions of Cd2+. The inotropic Cd<sup>2+</sup> action on frog heart is studied with taking into account its toxic effects upon mitochondria. Cd<sup>2+</sup> at concentrations of 1, 1, and 2 mM is established to decrease dose dependently (21...

Eerola, A.; Jokinen, E.; Boldt, T.; Pihkala, J., 2006: The influence of percutaneous closure of patent ductus arteriosus on left ventricular size and function: a prospective study using two- and three-dimensional echocardiography and measurements of serum natriuretic peptides. OBJECTIVES We aimed to evaluate the effect of percutaneous closure of patent ductus arteriosus (PDA) on left ventricular (LV) hemodynamics.BACKGROUND Today, most PDAs are closed percutaneously. Little is known, however, about hemodynamic changes a...

Grundy, S.M., 2003: N-3 fatty acids: priority for post-myocardial infarction clinical trials. Circulation 107(14): 1834-1836

Pospichal James J.; Wei Wuchang; Wise Sherwood W.J., 1991: Data report; Indian Ocean Oligocene strontium isotope stratigraphy, legs 119-121, Kerguelen Plateau and Ninetyeast Ridge. Proceedings of the Ocean Drilling Program, Scientific Results 121: 921-930

Gregg, W.O., 1947: Another collecting trip in Southern California. Minutes of the Conchological Club of Southern California, 70: 7-8

Bohrer, B.C.; Merenbloom, S.I.; Koeniger, S.L.; Hilderbrand, A.E.; Clemmer, D.E., 2010: Biomolecule analysis by ion mobility spectrometry. Although nonnative protein conformations, including intermediates along the folding pathway and kinetically trapped misfolded species that disfavor the native state, are rarely isolated in the solution phase, they are often stable in the gas phase...

Steinberg, R.H., 1968: Central inhibition of retinal function?. The effects produced by illumination of 1 eye upon the discharge of the other, are insufficient to warrant the conclusion of Haft and Harmon that the retinal activity of the cat is regulated by central mechanisms.

Deutsch, M.; García, J.; Mendlovic, D., 1996: Multichannel single-output color pattern recognition by use of a joint-transform correlator. A novel method for performing color image recognition by the use of the coherent joint-transform correlator is introduced. The input plane of the proposed method is a spatial rearrangement of the separation into color channels of both the color in...

Perez, C.; Lucas, F.; Sclafani, A., 1998: Devazepide, and CCKA antagonist, attenuates the satiating but not the preference conditioning effects of intestinal carbohydrate infusions in rats. Endogenous cholecystokinin (CCK) is thought to participate in the satiating action of foods, and some data suggest that it may also mediate their postingestive reinforcing effects. This was investigated by determining if the CCKA receptor antagoni...

Mangal, P.C.; Verma, K.B., 1979: Effect of induced skin cancer on the concentrations of some trace elements in the mouse. The concentrations of 10 trace elements (Se, Cr, Fe, Co, Zn, Sc, Rb, Ag and Sb) were investigated in normal and cancerous mouse skin employing neutron activation technique without chemical separation. The use of Ge (Li) detectors having active vol...