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For the OLIF approach, MRI evidence indicates lower lumbar segmental arteries traverse the intervertebral disc
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Investigators of this study found segmental arteries in the lower lumbar spine level of L4 -L5 can exist in the surgical field of the oblique lateral interbody fusion, which could lead to risk of arterial injury.
“Segmental arteries can be involved in the surgical field of [oblique lateral interbody fusion] OLIF especially in the lower lumbar spine level of L4 and L5 arteries, which can directly run across [intervertebral discs] IVDs. L5 segmental arteries can also be iliolumbar arteries that have an abnormal trajectory by nature,” the researchers wrote.
Researchers reviewed 272 lumbar MRIs of patients with lower back pain complaints. To determine whether the segmental arteries ran into the surgical area, investigators measured the cephalad/caudal distances from the center angles and branch angles of the segmental arteries to longitudinal axes of the aorta. The center of the virtually installed oblique lateral interbody fusion retractor was comprised of the intersection of one-third of the anterior lines and median lines of the intervertebral disc seen in the sagittal images.
Findings showed in the L1-L3 arteries, the branch angles of the segmental arteries were significantly acute and in the L4-L5 arteries the angles were significantly blunt. Investigators noted the distance to the caudal adjacent intervertebral disc, on average, was significantly larger. The possibilities were low for the segmental arteries to exist below half of the vertebral height, which the investigators noted is where surgeons can easily and safely place fixation pins.
According to researchers, arteries in L5 demonstrated characteristics of significant deviation, with an adjacency rate that was four-times higher and a 38.9% lower rate of existence compared to other segmental arteries. – by Monica Jaramillo
Disclosure: The researchers report no relevant financial disclosures.
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