Clinical anatomic study of the lower lumbar anterolateral vein: with respect to retroperitoneal endoscopic surgery.
OBJECTIVE
To study the anatomy of veins of the lower lumbar spine and provide the anatomic basement for laparoscopic lumbar surgery.


METHODS
A total of 15 formaldehyde-preserved cadavers were studied with special attention to the variety and surrounding structure of ascending lumbar vein (ALV) and iliolumbar veins (ILV), and their relationship with lumbar plexus.


RESULTS
ALV and ILV can be found on every sides, which have four variants including separate entry and common entry. The ascending vein and iliolumbar vein separately enter common iliac vein in 18 cases, and as a common stem enter the common iliac vein in 12 cases. Retracting common iliac vein medially both the ascending lumbar and the iliolumbar veins are always at risk of avulsion on exposure of the disc space. The injury of obturator nerve and lumbosacral trunk of lumbar plexus should be avoided.


CONCLUSIONS
Awareness of these anatomic variation can prevent the hemorrhage and be helpful for the surgeon in performing a careful ligation of these veins before medial retraction of the common iliac vein. Our findings emphasize the need for proper dissection of ALV and ILV before ligature during exposure of the lower lumbar spine.
Lu
Sheng
S
Department of Orthopedics, Kunming General Hospital, Chengdu Military Region of PLA, Kunming 650032, China. ls730327@163.com
Xu
Yong-qing
YQ
Ding
Zi-hai
ZH
Wang
Yue-li
YL
Shi
Ji-hong
JH
Zhong
Shi-zhen
SZ
D002102:Cadaver; D004724:Endoscopy; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000098:blood supply*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D012187:Retroperitoneal Space; D014680:Veins / Q000033:anatomy & histology