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The Relevant Anatomy of the Approach for Axial Lumbar Interbody Fusion

Li, Xiangming, MD; Zhang, Yusong, MD; Hou, Zhidian, MDPhD; Wu, Tao, MD, PhD; Ding, Zihai, MD

doi: 10.1097/BRS.0b013e31821b8f6d
Anatomy

Study Design. Prospective trial.

Objective. To perform a precise anatomical study of the presacral space and to examine the approach safety of AxiaLIF (axial lumbar interbody fusion) in an anatomical aspect.

Summary of Background Data. AxiaLIF is a novel, minimally invasive surgery. Though there were a few clinical reports on its safety, AxiaLIF is less used in current practice because of the unfamiliarity of surgeons with the regional anatomy of presacral space.

Methods. Sixteen adult cadaveric pelvic specimens were divided along the median sagittal plane. The presacral fascial structures, the rectosacral fascia, and the pelvic splanchnic nerves were dissected and measured. In the simulated operation, a blunt guide pin was inserted bilaterally to determine the relation of the guide pin's path with important anatomic structures. Mean distances with 95% confidence intervals (CIs) were calculated.

Results. The results showed that the fascial structures of the presacral space were divided into 5 layers, and the pelvic splanchnic nerves limited the dissection of the lower rectum, the mean length of which was 2.2 cm (1.9–2.5 cm). In the simulated operation, the mean minimum distance from the guide pin to the pelvic splanchnic nerves was 0.8 cm (0.4–1.2 cm), and the mean vertical distance to the S3–S4 junction was 1.5 cm (1.2–1.7 cm).

Conclusion. Our study suggests that the approach for AxiaLIF is risky and requires further modification. We should choose the accurate surgical plane when performing the presacral approach.

Sixteen cadaveric pelvic specimens were divided. The fascial structures of the presacral space and the relation of the guide pin's path for AxiaLIF with important anatomic structures was measured and analyzed. This study suggests that the approach for AxiaLIF is risky, which requires it to be further modified.

From the Institute of Clinical Anatomy, Southern Medical University, Guangzhou, China

Address correspondence and reprint requests to Zihai Ding, MD, Institute of Clinical Anatomy, Southern Medical University, Guangzhou, Guangdong Province, PR China 510515; E-mail: dingzihai@126.com

Acknowledgment date: November 30, 2010. First revision date: January 23, 2011. Second revision date: March 18, 2011. Acceptance date: March 20, 2011.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.

© 2012 Lippincott Williams & Wilkins, Inc.