Peridiscal vascular anatomy of the lower lumbar spine : An endoscopic perspective

An analysis of the vascular anatomy relative to the underlying discs in the lower lumbar spine performed by using radiologic studies. To define better the vascular anatomy of this region from the perspective of the endoscopic spine surgeon, and to draw conclusions regarding surgical accessibility of...

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Veröffentlicht in:Spine (Philadelphia, Pa. 1976) Pa. 1976), 1999-11, Vol.24 (21), p.2183-2187
Hauptverfasser: VRANEY, R. T, PHILLIPS, F. M, WETZEL, F. T, BRUSTEIN, M
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container_issue 21
container_start_page 2183
container_title Spine (Philadelphia, Pa. 1976)
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creator VRANEY, R. T
PHILLIPS, F. M
WETZEL, F. T
BRUSTEIN, M
description An analysis of the vascular anatomy relative to the underlying discs in the lower lumbar spine performed by using radiologic studies. To define better the vascular anatomy of this region from the perspective of the endoscopic spine surgeon, and to draw conclusions regarding surgical accessibility of the lower lumbar intervertebral discs. Cadaveric studies have highlighted the high degree of anatomic variability among the vascular structures overlying the anterior elements of the lower lumbar spine. An endoscopic approach to the intervertebral disc at these levels often is limited by arterial or venous structures. The growth of laparoscopic techniques to approach the intervertebral disc has renewed interest in the vascular anatomy of this region. A computer-generated series of abdominal vascular studies performed for unrelated indications were scrutinized to ensure clear demarcation of the overlying vascular structures and underlying bony anatomy of the lumbar spine in a true anteroposterior plane. For analysis, 21 arterial (abdominal angiograms) and 22 venous (venograms) studies were selected. For the arterial data, level of aortic bifurcation and course of common iliac vessels were determined. The venous data were analyzed in a similar manner using the confluence of the common iliac veins as the major landmark. To draw conclusions about anterior surgical accessibility of the disc, the location of vessels was measured with respect to intervertebral disc spaces. The bifurcation level of the abdominal aorta was quite variable, occurring anteriorly to the L3 vertebral body in 3 of 21 studies (14%), and anteriorly to L4 and L5 in 10 (48%) and 7 (38%) of the studies, respectively. The cranial half of L5 was the most common single area of bifurcation (in one third of the studies). Venous anatomy was more consistent, with 86% of the patients displaying an iliac vein confluence at L5, and 14% having a confluence overlying L4. From an arterial perspective the L3-L4, L4-L5, and L5-S1 discs were readily accessible in 10%, 38%, and 95% of the studies, respectively. From a venous perspective, these levels were accessible in 100%, 73%, and 60% of the studies, respectively. The results of this study suggest that a laparoscopic approach to the L3-L4 intervertebral disc will seldom be accomplished without significant retraction of the aorta. Access to the L4-L5 space will be accomplished readily in approximately one third of the patients. In the others, it will require sig
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Cadaveric studies have highlighted the high degree of anatomic variability among the vascular structures overlying the anterior elements of the lower lumbar spine. An endoscopic approach to the intervertebral disc at these levels often is limited by arterial or venous structures. The growth of laparoscopic techniques to approach the intervertebral disc has renewed interest in the vascular anatomy of this region. A computer-generated series of abdominal vascular studies performed for unrelated indications were scrutinized to ensure clear demarcation of the overlying vascular structures and underlying bony anatomy of the lumbar spine in a true anteroposterior plane. For analysis, 21 arterial (abdominal angiograms) and 22 venous (venograms) studies were selected. For the arterial data, level of aortic bifurcation and course of common iliac vessels were determined. The venous data were analyzed in a similar manner using the confluence of the common iliac veins as the major landmark. 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The results of this study suggest that a laparoscopic approach to the L3-L4 intervertebral disc will seldom be accomplished without significant retraction of the aorta. Access to the L4-L5 space will be accomplished readily in approximately one third of the patients. In the others, it will require significant vascular dissection. The L5-S1 space, conversely, will be readily accessible by the authors' definitions without significant vessel dissection in the majority of patients.</abstract><cop>Philadelphia, PA</cop><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>10562981</pmid><doi>10.1097/00007632-199911010-00002</doi><tpages>5</tpages></addata></record>
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ispartof Spine (Philadelphia, Pa. 1976), 1999-11, Vol.24 (21), p.2183-2187
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subjects Adult
Aged
Aged, 80 and over
Aortography
Biological and medical sciences
Endoscopy - adverse effects
Endoscopy - methods
Female
Fundamental and applied biological sciences. Psychology
Humans
Intervertebral Disc - blood supply
Intervertebral Disc - diagnostic imaging
Intervertebral Disc - surgery
Lumbar Vertebrae - blood supply
Lumbar Vertebrae - diagnostic imaging
Lumbar Vertebrae - surgery
Male
Middle Aged
Phlebography
Skeleton and joints
Vertebrates: osteoarticular system, musculoskeletal system
title Peridiscal vascular anatomy of the lower lumbar spine : An endoscopic perspective
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