| ObjectiveIn recent years,more and more attention has been paid to the treatment of vertebral(lumbar)tumors by posterior-only total en bloc spondylectomy.It was well known the way to reveal the segmental spinal arteries of the lumbar vertebra by way of lateral-anterior approach in the past.Because of the inability to operate under direct vision,the treatment of segmental arteries in the posterior-only approach is not as easy as the lateral-anterior approach.At the same time,there was no detailed literature to support and elaborate.Therefore,the problem of large amount of bleeding and the nondeterminacy in operation has not been solved well.The authors intended to observe and measure through autopsy,hoping to provide anatomy basis for the treatment of segmental spinal arteries with posterior-only approach for lumbar spine surgery.MethodThe authors selected 9 normal adult cadavers(7 male and 2 female)immobilized by Formalin without dysplasia and post-traumatic deformity.Their height ranged from 160 to 185 cm,and their age ranged from 30 to 70 years old.They simulated TES surgery and performed anatomical operations.First,they stripped the posterior side of the body and removed the psoas and the transverse ligament in order to expose every lumbar nerve root and intervertebral foramen.Next they excised the dorsal muscle with bone structural markers such as vertebral pedicle,accessory synapses and transverse synapses retained.From the rear of the body the authors observed and confirmed that the segmental artery branches of the lumbar vertebra could be clearly seen.For further measurement,the body was supine on the anatomical table.They cut the ribs in the middle of the axillary midline,exposing the chest and the abdomen.Then they stripped away the abdominal organs,but the main vessels such as the aorta abdominalis,postcava,arteria iliac communis and iliac vena iliac communis were preserved.After that they could see the segmental arteries of the vertebral body emitted by the abdominal aorta.Be careful not to disrupt its association with the various vertebral bodies.They cut the intertransverse muscle and intertransverse ligament of the lumbar spine,remembering to protect the branches of the segmental arteries for the rear muscles.Then they used the professional instrument gently pulling and protecting the nerve root to observe the segmental spinal artery branches.They confirmed that the posterior-only approach could surely cause the accidental injury by being unfamiliar with the location of the arteries.Finally,through observation and analysis authors chose the transverse process as a reliable bony reference from many bone structures.They set the starting point at the furcation where the segmental artery was close to the vertebral body and has not yet formed a branch of the vertebral canal,outer and posterior location.They respectively set the endpoint at the apex of the transverse process and at the root of the transverse process to measure.Eventually,the linear distance between two points was measured and analyzed statistically.ResultsThe author set the transverse apex as a measuring marker to Group A and the root of the transverse process as a marker to Group B.After measurement,the corresponding data were calculated and.Then they used T-Test on the left and right sides of each segment data to verify that there were no statistically significant differences between left and right sides(P>0.05),so they could combine the two sides analysis into one.The authors could get the following results.Group A,L1(22.41±4.333)mm;L2(27.90±2.859)mm;L3(31.29±2.842)mm;L4(27.45±3.799)mm;L5(29.70±2.980)mm.Group B,L1(10.17±1.490)mm;L2(10.74±1.543)mm;L3(10.70±1.500)mm;L4(10.87±1.277)mm;L5(10.79±1.465)mm.Then they looked at the original data in detail and found that one of the data was notably different from the other eight because of the larger size of the body itself,which made the measured data fluctuate obviously and affected the measurement accuracy.So after they removed this set of data,they calculated it and used T-Test on it(P>0.05)in the same way.They got the following results.Group a,L1(21.55±3.721)mm;L2(27.30±2.277)mm;L3(30.67±2.351)mm;L4(26.72±3.307)mm;L5(29.20±2.762)mm.Group b,L1(9.92±1.375)mm;L2(10.46±1.378)mm;L3(10.46±1.402)mm;L4(10.65±1.161)mm;L5(10.59±1.414)mm.ConclusionAccording to the posterior anatomy and observation of lumbar vertebrae,they selected the appropriate anatomical structure of the spine--"transverse process" as the reference for measurement,which resulted in getting detailed data and understanding the relationship between the segmental arteries and the transverse process with success.It could not only help the surgeon to avoid accidental injury during the process of operation,but also could complete the intraoperative segmental vascular ligation under the proper condition.To some extent,this research could help surgeons reduce unnecessary blood loss and unnecessary prolonged operation time. |
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