Radiographic Study of Lumbar Sympathetic Trunk in Oblique Lateral Interbody Fusion Surgery

Hongli Wang; Yuxuan Zhang; Xiaosheng Ma; Xinlei Xia; Feizhou Lu; Jianyuan Jiang

doi:10.1016/j.wneu.2018.04.212

Radiographic Study of Lumbar Sympathetic Trunk in Oblique Lateral Interbody Fusion Surgery

World Neurosurg. 2018 Aug:116:e380-e385. doi: 10.1016/j.wneu.2018.04.212. Epub 2018 May 9.

Authors

Hongli Wang¹, Yuxuan Zhang¹, Xiaosheng Ma¹, Xinlei Xia¹, Feizhou Lu², Jianyuan Jiang³

Affiliations

¹ Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
² Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China; The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China.
³ Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China. Electronic address: jjyfudanspine@126.com.

PMID: 29751180
DOI: 10.1016/j.wneu.2018.04.212

Abstract

Background: Oblique lateral interbody fusion (OLIF) surgery provides a convenient and minimal access to the lesion disc with few complications; however, the left lumbar sympathetic trunk (LST) lies in the surgical field with a certain incidence of injury. The aim of this study was to describe the anatomic structures of the left LST at risk for injury during OLIF at different lumbar segment levels based on radiologic evaluations.

Methods: Forty-four healthy young people (22 men and 22 women) were recruited, and routine lumbar magnetic resonance radiograph was performed. The LST, abdominal aorta (AA), and psoas muscle (PM) were observed, and all parameters were acquired using axial T2-weighted turbo spin echo sequence images. Independent-samples t test, 1-way analysis of variance test, and Least significant difference test were used to explore the LST's tract and the anatomic relationship with the adjacent anatomic landmarks at different levels.

Results: The distance from the left lateral border of the AA to the anterior medial border of the left PM was significantly narrowing from the L2-3 to L4-5 segment levels (13.72 ± 3.00, 11.78 ± 2.69, and 9.18 ± 3.43 mm). The distance from the left lateral border of the AA to the left LST was also significantly decreased from the L2-3 to L4-5 segment levels (11.14 ± 2.89, 9.36 ± 2.79, and 6.63 ± 2.94 mm). However, the distance from the leading edge of the left PM to the left LST had no statistical differences among all adjacent segment levels (2.96 ± 0.62, 2.83 ± 0.62, and 3.07 ± 0.86 mm). The location of the left LST is more backward and lateral at level L2-3, whereas it is inside front at levels L3-4 and L4-5.

Conclusions: The practical risk of LST injury in different segment levels varied with specific anatomic conditions. The segment level L2-3 could provide a safer surgical space for OLIF, and the risk of the left LST injury might be greater during OLIF at level L4-5.

Keywords: Anatomic study; Lumbar sympathetic trunk; OLIF; Oblique lateral interbody fusion; Radiologic evaluation.

MeSH terms

Adrenergic Fibers*
Adult
Female
Humans
Lumbar Vertebrae / diagnostic imaging*
Lumbar Vertebrae / innervation
Lumbar Vertebrae / surgery*
Lumbosacral Plexus / diagnostic imaging*
Lumbosacral Plexus / surgery*
Male
Spinal Fusion / methods*
Young Adult