title: Neurovascular structures adjacent to the lumbar intervertebral discs: an anatomical study of their morphometry and relationships.
abstract: OBJECTIVE
  Although infrequent, injury to adjacent neurovascular structures during posterior approaches to lumbar intervertebral discs can occur. A detailed anatomical knowledge of relationships may decrease surgical complications.
  
  
  METHODS
  Ten formalin-fixed male cadavers were used for this study. Posterior exposure of the lumbar thecal sac, nerve roots, pedicles, and intervertebral discs was performed. To identify retroperitoneal structures at risk during posterior lumbar discectomy, a transabdominal retroperitoneal approach was performed, and observations were made. The distances between the posterior and anterior edges of the lumbar intervertebral discs were measured, and the relationships between the disc space, pedicle, and nerve root were evaluated.
  
  
  RESULTS
  For right and left sides, the mean distance from the inferior pedicle to the disc gradually increased from L1-2 to L4-5 (range 2.7-3.8 mm and 2.9-4.5 mm for right and left side, respectively) and slightly decreased at L5-S1. For right and left sides, the mean distance from the superior pedicle to the disc was more or less the same for all disc spaces (range 9.3-11.6 mm and 8.2-10.5 mm for right and left, respectively). The right and left mean disc-to-root distance for the L3-4 to L5-S1 levels ranged from 8.3 to 22.1 mm and 7.2 to 20.6 mm, respectively. The root origin gradually increased from L-1 to L-5. The right and left nerve root-to-disc angle gradually decreased from L-3 to S-1 (range 105°-110.6° and 99°-108°). Disc heights gradually increased from L1-2 to L5-S1 (range 11.3-17.4 mm). The mean distance between the anterior and posterior borders of the intervertebral discs ranged from 39 to 46 mm for all levels.
  
  
  CONCLUSIONS
  To avoid neighboring neurovascular structures, instrumentation should not be inserted into the lumbar disc spaces more than 3 cm from their posterior edge. Accurate anatomical knowledge of the relationships of intervertebral discs to nerve roots is needed for spine surgeons.
authors.affiliation: Department of Neurosurgery, Yuzuncu Yıl University, Faculty of Medicine, Van, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Arslan
authors.forename: Ayhan
authors.initials: A
authors.lastname: Cömert
authors.forename: Halil İbrahim
authors.initials: Hİ
authors.lastname: Açar
authors.forename: Mevci
authors.initials: M
authors.lastname: Özdemir
authors.forename: Alaittin
authors.initials: A
authors.lastname: Elhan
authors.forename: İbrahim
authors.initials: İ
authors.lastname: Tekdemir
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Ayhan
authors.initials: A
authors.lastname: Attar
authors.forename: Hasan Çağlar
authors.initials: HÇ
authors.lastname: Uğur
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D017586:Diskectomy; D006801:Humans; D007403:Intervertebral Disc / Q000098:blood supply* / Q000294:innervation*; D008161:Lumbosacral Region / Q000098:blood supply* / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D013126:Spinal Nerve Roots / Q000033:anatomy & histology*