Michele Davis1, Skyler Jenkins2, Stephen Bordes2, Joe Iwanaga3, Marios Loukas2, Juan Uribe4, Richard A Hynes5, R Shane Tubbs1. 1. Seattle Science Foundation, Seattle, Washington, USA. 2. Department of Anatomical Sciences, St. George's University, St. George's, Grenada. 3. Seattle Science Foundation, Seattle, Washington, USA. Electronic address: joei@seattlesciencefoundation.org. 4. Barrow Neurological Institute, Phoenix, Arizona, USA. 5. The B.A.C.K. Center, Melbourne, Florida, USA.
Abstract
OBJECTIVE: Safe surgical approaches to the anterolateral lumbar spine require a good working knowledge of the anatomy and anatomic variations of this region. As the iliolumbar vein is in the vicinity of both oblique and lateral transpsoas approaches to the lower lumbar spine, the following study was performed to better elucidate its anatomy, variations, and position during such surgical procedures. METHODS: Fifteen (30 sides) fresh frozen adult cadavers underwent dissection of the iliolumbar vein (ILV). The origin, course, variants, relations, and morphometrics of each vein were documented. Fluoroscopy of the vessels was performed. Lastly, anterior oblique and lateral transpsoas approaches to the lumbar spine were carried out in order to evaluate for potential ILV injury. RESULTS: An ILV was found on all but 2 sides (93.3%). It arose as a common trunk from the common iliac vein on 14 sides. Left ILVs tended to have a more distal origin than right ILVs. ILVs had a mean length of 3.7 cm and a mean width of 0.9 cm and were significantly larger on right versus left sides (P < 0.05). Left-sided ILVs tended to have more branches than right-sided veins. The majority of vertical branches of the ILV traveled anterior to the ventral rami of the lumbar spinal nerves, most commonly L4. The ILV and, in particular, its vertical branches coursed next to the L4 and L5 vertebrae. CONCLUSIONS: The ILV should be considered during both oblique and lateral transpsoas approaches to the lumbar spine.
OBJECTIVE: Safe surgical approaches to the anterolateral lumbar spine require a good working knowledge of the anatomy and anatomic variations of this region. As the iliolumbar vein is in the vicinity of both oblique and lateral transpsoas approaches to the lower lumbar spine, the following study was performed to better elucidate its anatomy, variations, and position during such surgical procedures. METHODS: Fifteen (30 sides) fresh frozen adult cadavers underwent dissection of the iliolumbar vein (ILV). The origin, course, variants, relations, and morphometrics of each vein were documented. Fluoroscopy of the vessels was performed. Lastly, anterior oblique and lateral transpsoas approaches to the lumbar spine were carried out in order to evaluate for potential ILV injury. RESULTS: An ILV was found on all but 2 sides (93.3%). It arose as a common trunk from the common iliac vein on 14 sides. Left ILVs tended to have a more distal origin than right ILVs. ILVs had a mean length of 3.7 cm and a mean width of 0.9 cm and were significantly larger on right versus left sides (P < 0.05). Left-sided ILVs tended to have more branches than right-sided veins. The majority of vertical branches of the ILV traveled anterior to the ventral rami of the lumbar spinal nerves, most commonly L4. The ILV and, in particular, its vertical branches coursed next to the L4 and L5 vertebrae. CONCLUSIONS: The ILV should be considered during both oblique and lateral transpsoas approaches to the lumbar spine.
Authors: Evan Courville; Benjamin J Ditty; Christopher M Maulucci; Joe Iwanaga; Aaron S Dumont; R Shane Tubbs Journal: Neurosurg Rev Date: 2022-03-14 Impact factor: 3.042