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An MRI study of lateral vascular safety zones in oblique lumbar interbody fusion surgery – Lumbar Fusion

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The article titled “Anatomical Characteristics of Blood Vessels in the Lateral Segment of the Vertebral Body and Potential Vascular Safety Zone in Oblique Lumbar Interbody Fusion: A Magnetic Resonance Imaging-based Study” discusses the anatomical features of blood vessels in the lateral segment of the vertebral body and assesses its potential vascular safety zone. The study analyzes lumbar MRI data from 107 patients with low back and leg pain and measures various parameters such as vascular emanation angles, vascular travel angles, and vessel length. The authors found significant differences in these measurements among different vertebral segments. They also identified the proportion of vessels within simulated channels and concluded that the L1 and L5 segments are more prone to injury in specific zones. The study suggests the optimal placement of fixation pins based on these findings

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

: L (1) and L (5) segmental vessels are most likely to be injured in Moro zones Ⅰ and Ⅱ, and the placement of OLIF channels in L (4, 5) at Ⅲ, Ⅳ junction should be avoided. It is usually safe to place fixation pins at the vertebral body edge on the cephalic side of the intervertebral space, but it is safer to place them on the caudal side in L (1, 2) (Ⅰ, Ⅱ junction), L (3, 4) (Ⅲ, Ⅳ junction), and L (4, 5) (Ⅱ, Ⅲ, Ⅳ junctions).

Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Sep 15;37(9):1119-1126. doi: 10.7507/1002-1892.202305077.ABSTRACTOBJECTIVE: To study the anatomical characteristics of blood vessels in the lateral segment of the vertebral body through the surgical approach of oblique lumbar interbody fusion (OLIF) using MRI imaging, and evaluate its potential vascular safety zone.METHODS: The lumbar MRI data of,

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Sep 15;37(9):1119-1126. doi: 10.7507/1002-1892.202305077.

ABSTRACT

OBJECTIVE: To study the anatomical characteristics of blood vessels in the lateral segment of the vertebral body through the surgical approach of oblique lumbar interbody fusion (OLIF) using MRI imaging, and evaluate its potential vascular safety zone.

METHODS: The lumbar MRI data of 107 patients with low back and leg pain who met the selection criteria between October 2019 and November 2022 were retrospectively analyzed. The vascular emanation angles, vascular travel angles, and the length of vessels in the lateral segments of the left vertebral body of L 1-L 5as well as the distance between the segmental vessels in different Moro junctions of the vertebral body and their distances from the edges of the vertebrae in the same sequence (bottom marked as I, top as S) were measured. The gap between the large abdominal vessels and the lateral vessels of the vertebral body was set as the lateral vascular safe zones of the lumbar spine, and the extent of the safe zones (namely the area between the vessels) was measured. The anterior 1/3 of the lumbar intervertebral disc was taken as the simulated puncture center, and the area with a diameter of 22 mm around it as the simulated channel area. The proportion of vessels in the channel was further counted. In addition, the proportions of segmental vessels at L 5 without a clear travel and with an emanation angel less than 90° were calculated.

RESULTS: Except for the differences in the vascular emanation angles between L 4 and L 5the vascular travel angles between L 1L 2 and L 4L 5and the length of vessels in the lateral segments of the vertebral body among L 1-L 4 were not significant ( P>0.05), the differences in the vascular emanation angles, vascular travel angles, and the length of vessels between the rest segments were all significant ( P<0.05). There was no significant difference in the distance between vessels of L 1L 2 and L 2L 3 at Moro Ⅰ-Ⅳ junctions ( P>0.05), in L 3L 4 and L 4L 5 at Ⅱ and Ⅲ junction ( P>0.05). There was no significant difference in the vascular distance of L 2L 3 between Ⅱ, Ⅲ junction and Ⅲ, Ⅳ junction, and the vascular distance of L 3L 4 between Ⅰ, Ⅱ junction and Ⅲ, Ⅳ junction ( P>0.05). The vascular distance of the other adjacent vertebral bodies was significant different between different Moro junctions ( P<0.05). Except that there was no significant difference in the distance between L 2I and L 3S at Ⅰ, Ⅱ junction, L 3I and L 4S at Ⅱ, Ⅲ junction, and L 2I and L 3S at Ⅲ, Ⅳ junction ( P>0.05), there was significant difference of the vascular distance between the bottom of one segment and the top of the next in the other segments ( P<0.05). Comparison between junctions: Except for the L 3S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ junction, and L 5S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ and Ⅲ, Ⅳ junctions had no significant difference ( P>0.05), there were significant differences in the distance between the other segmental vessels and the vertebral edge of the same sequence in different Moro junctions ( P<0.05). The overall proportion of vessels in the simulated channels was 40.19% (43/107), and the proportion of vessels in L 1 (41.12%, 44/107) and L 5 (18.69%, 20/107) was higher than that in the other segments. The proportion of vessels in the channel of Moro zone Ⅰ (46.73%, 50/107) and zone Ⅱ (32.71%, 35/107) was higher than that in the zone Ⅲ, while no segmental vessels in L 1 and L 2 were found in the channel of zone Ⅲ ( h 2=74.950, P<0.001). Moreover, 26.17% (28/107) of the segmental vessels of lateral L 5 showed no movement, and 27.10% (29/107) vascular emanation angles of lateral L 5 were less than 90°.

: 1 and L 5 segmental vessels are most likely to be injured in Moro zones Ⅰ and Ⅱ, and the placement of OLIF channels in L 4, 5 at Ⅲ, Ⅳ junction should be avoided. It is usually safe to place fixation pins at the vertebral body edge on the cephalic side of the intervertebral space, but it is safer to place them on the caudal side in L 1, 2 (Ⅰ, Ⅱ junction), L 3, 4 (Ⅲ, Ⅳ junction), and L 4, 5 (Ⅱ, Ⅲ, Ⅳ junctions).

PMID:37718425 | DOI:10.7507/1002-1892.202305077

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An MRI study of lateral vascular safety zones in oblique lumbar interbody fusion surgery

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Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Sep 15;37(9):1119-1126. doi: 10.7507/1002-1892.202305077.ABSTRACTOBJECTIVE: To study the anatomical characteristics of blood vessels in the lateral segment of the vertebral body through the surgical approach of oblique lumbar interbody fusion (OLIF) using MRI imaging, and evaluate its potential vascular safety zone.METHODS: The lumbar MRI data of

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