Morphometric analysis of the lumbar vertebrae and intervertebral discs in relation to abdominal aorta: CT-based study
- PMID: 34874459
- PMCID: PMC8917002
- DOI: 10.1007/s00276-021-02865-9
Free PMC article
Abstract
Purpose: Although lumbar discectomy is the most common procedure in spine surgery, reports about anatomical relations between discs and prevertebral vessels are limited. Aim of this research was to investigate morphometric of the lumbar region and the relations between intervertebral discs (IVDs) and abdominal aorta.
Methods: 557 abdominal computed tomography scans were assessed. For each spinal column level from Th12/L1 down to L4/L5, we investigated: intervertebral disc’s and vertebra’s height, width, length, and distance from aorta or common iliac artery (CIA). Those arteries were also measured in two dimensions and classified based on location.
Results: 54.58% of patients were male. There was a significant difference in arterial-disc distances (ADDs) between genders at the levels: L1/L2 (1.32 ± 1.97 vs. 0.96 ± 1.78 mm; p = 0.0194), L2/L3 (1.97 ± 2.16 vs. 1.15 ± 2.01 mm; p < 0.0001), L3/L4 (2.54 ± 2.78 vs. 1.71 ± 2.61 mm; p = 0.0012), also for both CIAs (left CIA 3.64 ± 3.63 vs. 2.6 ± 3.06 mm; p = 0.0004 and right CIA: 7.96 ± 5.06 vs. 5.8 ± 4.57 mm; p < 0.001)-those ADDs were higher in men at all levels. The length and width of IVD increased alongside with disc level with the maximum at L4/L5.
Conclusion: Bifurcations of the aorta in most cases occurred at the L4 level. Collected data suggest that at the highest lumbar levels, there is a greater possibility to cause injury of the aorta due to its close anatomical relationship with discs. Females have limited, in comparison to males, ADD at L1/L2, L2/L3, and L3/L4 levels what should be taken into consideration during preoperative planning of surgical intervention.
Keywords: Aorta; Discectomy; Intervertebral disc; Lumbar vertebrae; Radiology; Vascular system injuries.
© 2021. The Author(s).
Conflict of interest statement
The authors declare that they have no conflict of interest.
Figures
Similar articles
-
Robot-assisted multi-level anterior lumbar interbody fusion: an anatomical study.Acta Neurochir (Wien). 2018 Oct;160(10):1891-1898. doi: 10.1007/s00701-018-3621-x. Epub 2018 Jul 24. PMID: 30039290
-
Anatomical Study of the Lumbar Segmental Arteries in Relation to the Oblique Lateral Interbody Fusion Approach.World Neurosurg. 2020 Jun;138:e778-e786. doi: 10.1016/j.wneu.2020.03.080. Epub 2020 Mar 23. PMID: 32217175
-
The importance of level stratification for quantitative MR studies of lumbar intervertebral discs: a cross-sectional analysis in 101 healthy adults.Eur Spine J. 2019 Sep;28(9):2153-2161. doi: 10.1007/s00586-019-06059-1. Epub 2019 Jul 12. PMID: 31309335
-
Morphometric MRI Imaging Study of the Corridor for the Oblique Lumbar Interbody Fusion Technique at L1-L5.World Neurosurg. 2018 Mar;111:e678-e685. doi: 10.1016/j.wneu.2017.12.136. Epub 2017 Dec 30. PMID: 29294391
-
Retroperitoneal oblique corridor to the L2-S1 intervertebral discs: an MRI study.J Neurosurg Spine. 2016 Feb;24(2):248-255. doi: 10.3171/2015.3.SPINE13976. Epub 2015 Oct 9. PMID: 26451662
References
-
- Bojarski P, Sobstyl M. Vascular iatrogenic injury during lumbar disc surgery: a literature review. Pol Merkur Lekarski. 2021;49:231–234. – PubMed
-
- Appaji CA, Kulkarni R, Pai DSB. Level of bifurcation of aorta and iliocaval confluence and its clinical relevance. IOSR J Dent Med Sci. 2014 doi: 10.9790/0853-13725660. – DOI
-
- Can H, Diren F, Peker B, Gomleksiz C, Guclu DG, Kucuk C, Civelek E, Aydoseli A, Sencer A. Morphometric analysis of lumbar arteries and relationship with intervertebral discs\’, a study of surgical anatomy on human fresh cadavers. Turk Neurosurg. 2020 doi: 10.5137/1019-5149.JTN.29021-20.1. – DOI – PubMed
-
- Keskinoz EN, Salbacak A, Akin D, Kabakci ADA, Yilmaz MT, Cicekcibasi AE, Ozbek O. Morphometric analysis of the inferior vena cava related to lumbar vertebra and the aortic bifurcation on multidetector computed tomography (MDCT) Int J Morphol. 2016 doi: 10.4067/s0717-95022016000200033. – DOI
-
- Khamanarong K, Sae-Jung S, Supa-adirek C, Teerakul S, Prachaney P. Aortic bifurcation: a cadaveric study of its relationship to the spine. J Med Assoc Thai. 2009;92(1):47–49. – PubMed
-
- Salagean M, Ginghina C, Geana RC, Dragulescu R, Balcangiu Stroescu A, Stiru O, Raducu L, Iliescu VA, Tulin A. Iatrogenic iliac arteriovenous fistula management after lumbar discectomy surgeries: a case report and review of the literature. Heart Surg Forum. 2020;23:E863–E866. doi: 10.1532/hsf.3289. – DOI – PubMed
-
- Vaccaro AR, Kepler CK, Rihn JA, Suzuki H, Ratliff JK, Harrop JS, Morrison WB, Limthongkul W, Albert TJ. Anatomical relationships of the anterior blood vessels to the lower lumbar intervertebral discs: analysis based on magnetic resonance imaging of patients in the prone position. J Bone Jt Surg Ser A. 2012 doi: 10.2106/JBJS.K.00671. – DOI – PubMed