Turkish Neurosurgery
A Morphometric Study with Cadavers for Anterior Approach to the Lower Lumbar Spine
Halil Can1, Onur Ozturk2, Erdinc Civelek3, Huseyin Dogu1, Osman Boyali3, Ceyhun Kucuk4, Aydin Aydoseli5, Altay Sencer5
1Atlas University Faculty of Medicine, Neurosurgery, Istanbul,
2Acibadem Taksim Hospital, Neurosurgery, Istanbul,
3Istanbul Gaziosmanpasa Training and Research Hospital, Neurosurgery, Istanbul,
4Turkish Republic Ministry of Justice Forensic Medicine Institution, Morgue, Istanbul,
5Istanbul University Istanbul Faculty of Medicine, Neurosurgery, Istanbul,
DOI: 10.5137/1019-5149.JTN.43447-23.2

Aim:An important complication of the anterior approach to the lower lumbar spine is vascular injury. Arterial and venous vasculature varies in size and origin, which may limit the surgical zone and compromise the safety under specific circumstances. We aimed to explore the relationship between the retroperitoneal vasculature and anterior surface of the lower spine and establish values to aid in predicting the pertinence of anterior approach for the intervertebral disks at the L4-L5 and L5-S1 levels.Material and Methods:The study included 13 fresh human cadavers. After exploration of the abdominal cavity and removal of the visceral organs, the vasculature, and anterior spinal surface were revealed beneath the lower extension of the perirenal fascia. Morphometric measurements of the great vessels and the intervertebral disks were obtained. All measurements were analyzed and presented as mean and standard deviation. Differences in the values between sexes were assessed.Results:The anterior height of the L4-L5 and L5-S1 intervertebral disk was 6.8 ± 0.81 mm and 6.7 ± 0.99 mm, respectively. The widths of the aorta, inferior vena cava, right and left common iliac arteries, and right, and left common iliac veins were 16.4 ± 3.58, 20.6 ± 3.36, 11.5 ± 2.32, 11.5 ± 2.43, 14.7 ± 3.13, and 15.5 ± 3.27 mm, respectively. The mean aortic bifurcation angle was 45.5°. The aortic bifurcation was located above the lower endplate of the L4 vertebrae in 53.8% of the cadavers. The area of the interarterial and interiliac trigones was 14.6 ± 5.33 cm2 and 7.1 ± 4.35 cm2, respectively. No statistically significant differences were noted between the sexes.Conclusion:An elaborate radiological examination of the vasculature should be performed prior to surgery to avoid unwanted vascular complications during the anterior approach. Knowing the area of the interarterial and interiliac triangles and the aortic bifurcation location could be aid in assessing the safe working zone.

Corresponding author : Onur Ozturk