Quantitative anatomical and morphological classification of the iliac vessels anterior to the lumbosacral vertebrae.
OBJECTIVE
Anterior surgical approaches to the lumbosacral disc spaces are being undertaken with increasing frequency. This increase and the use of minimally invasive techniques themselves have the potential to raise the incidence of major vessel injuries. The purpose of this study was to determine the variability of the vascular anatomy anterior to the lumbosacral spine and to draw conclusions regarding surgical accessibility of the L5-S1 disc space.


METHODS
Thirty-five cadavers (age range at the time of death 31-87 years) were obtained to evaluate the anatomical features of iliac vessels with respect to the anterior approach to the lumbosacral spine. Direct measurement and morphological classification regarding the relations of these great vessels to the four arbitrary reference points of the lumbosacral disc space were performed. The mean width and height of the L5-S1 disc were 56.4 mm (range 41.6-65.4 mm) and 18.8 mm (range 10-24 mm), repectively. According to the authors' morphological classification, nine specimens (26%) were found to be Type A (standard), 12 (34%) Type B (narrow), two (6%) Type C (ajar), and 12 (34%) Type D (obstacle).


CONCLUSIONS
The authors have noted quite a variation in the venous vascular anatomy anterior to the lumbosacral disc. During surgical planning for the anterior approach to the lumbosacral spine when using any technique, it is vital to assess carefully radiographic and neuroimaging studies to minimize potentially disastrous vascular complications.
Cho
Do-Sang
DS
Department of Neurosurgery, Ewha Women's University Mokdong Hospital, Seoul, Korea.
Kim
Sang-Jin
SJ
Seo
Eui-Kyo
EK
Chung
In-Hyuk
IH
Oh
Chang-Seok
CS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000033:anatomy & histology*; D007084:Iliac Vein / Q000033:anatomy & histology*; D007403:Intervertebral Disc / Q000098:blood supply* / Q000601:surgery; D008161:Lumbosacral Region / Q000098:blood supply / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000469:parasitology*; D012039:Regional Blood Flow