Vascular injury risk stratification for lateral lumbar interbody fusion (LLIF) at L4-L5: a morphometric study using magnetic resonance imaging.

Autor:	Hirase T; Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA., Greenberg AJ; Premier Brain & Spine, Brooklyn, NY, USA., Ambrose CG; Department of Orthopedic Surgery, UT Health, Houston, TX, USA., Bernstein DT; Department of Orthopedics & Sports Medicine, Novant Health, Winston-Salem, NC, USA., Ratusznik JJ; Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, TX, USA., Marco RAW; Department of Orthopedic Surgery, UT Health, Houston, TX, USA.
Jazyk:	angličtina
Zdroj:	Journal of spine surgery (Hong Kong) [J Spine Surg] 2023 Dec 25; Vol. 9 (4), pp. 380-389. Date of Electronic Publication: 2023 Nov 27.
DOI:	10.21037/jss-23-94
Abstrakt:	Background: Proper vascular injury risk stratification (VIRS) methods for L4-L5 lateral lumbar interbody fusion (LLIF) surgery have not been well-described. The objective of this study was to propose a novel VIRS method for L4-L5 LLIF surgery via the transpsoas approach. Methods: Axial magnetic resonance imaging (MRI) of adult patients were obtained and analyzed. The VIRS scores were assessed using anterior disc line to posterior vessel wall distance, the disc vessel angle (DVA), and the disc edge to vessel distance at the level of L4-L5 disc space. Results: Ninety-one consecutive adult patients were included in the study. The right common iliac vein (CIV) had a high risk of injury with both right- and left-sided approaches. The left CIV had a moderate risk with a left-sided approach when the iliocaval confluence was above the L4-L5 disc space but had a high risk when the confluence was at the L4-L5 disc space. The left CIV had a high risk with a right-sided approach when the confluence was above the L4-L5 disc space but had a moderate risk when the confluence was at the L4-L5 disc space. The inferior vena cava (IVC) had a high risk with both right- and left-sided approaches. The aorta had a moderate risk regardless of the right or left-sided approaches. The left common iliac artery (CIA) had a moderate risk with a right-sided approach and a low risk with a left-sided approach. The right CIA had a low risk with both right- and left-sided approaches. Conclusions: There are significant vascular anatomic variations at the L4-L5 disc level and a proper VIRS can be performed utilizing a combination of anterior disc line to posterior vessel wall distance, DVA, and disc edge to vessel distance, on the axial MRI. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-23-94/coif). A.J.G. has the following disclosures that are unrelated to this article: Partner of Premier Brain & Spine. R.A.W.M. has the following disclosures that are unrelated to this paper: Royalties from Globus Medical. The other authors have no conflicts of interest to declare. (2023 Journal of Spine Surgery. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu