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The Anatomic Characteristics of the Retroperitoneal Oblique Corridor to the L1-S1 Intervertebral Disc Spaces

Wang, Kai, MD; Zhang, Can, MM; Wu, Hao, MD; Chen, Zan, MD; Chou, Dean, MD; Jian, Fengzeng, MD

doi: 10.1097/BRS.0000000000002951
ANATOMY
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Study Design. This is a cross-sectional study.

Objective. To investigate the oblique corridor to the L1-S1 intervertebral disc space between the psoas muscle and the great vessels in cadaveric specimens bilaterally and the location of genitofemoral nerve and the diaphragmatic crura relative to the oblique corridor.

Summary of Background Data. Although use of oblique lumbar interbody fusion is rapidly expanding, the morphometric data related to the procedure are limited.

Methods. Twelve fresh-frozen full-torso cadaveric specimens were dissected to examine the oblique corridor to access the L1-S1 space in a static state and with mild retraction of the psoas. The level at which the genitofemoral nerve pierces from the psoas major and the diaphragmatic crura originate from the lumbar vertebral body was also investigated.

Results. The mean width of oblique corridor in the static state and with mild psoas retraction, respectively, were as follows: on the right side: (L1–2) 13.33 and 16.75 mm; (L2–3) 15.42 and 21.42 mm; (L3–4) 16.58 and 22.67 mm; (L4–5) 12.75 and 21.17 mm; (L5–S1) 5.92 and 12.00 mm; on the left side: (L1–2) 16.75 and 19.67 mm; (L2–3) 18.50 and 25.33 mm; (L3–4) 20.58 and 28.00 mm; (L4-5) 18.17 and 26.08 mm; and (L5-S1) 5.83 and 12.00 mm. The level at which the genitofemoral nerve pierces from the psoas major was between L2 and L4. The diaphragmatic crura originates from L1 to L3.

Conclusion. The oblique corridor allows access to the L1-L5 discs from both sides, but it is larger on the left side. The corridor between the iliac vessels and the psoas for L5-S1 is difficult to be applied clinically. Mild psoas retraction can moderately enlarge the oblique corridor. The genitofemoral nerve and diaphragmatic crura may be encountered in this approach and should be carefully observed.

Level of Evidence: 5

The oblique corridor allows access to the L1-L5 discs from both sides, but it is larger on the left side. The corridor between the iliac vessels and the psoas for L5-S1 is difficult to be applied clinically. The genitofemoral nerve and diaphragmatic crura may be encountered in this approach and should be carefully observed.

Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China

Department of Neurosurgery, University of California San Francisco, San Francisco, CA.

Address correspondence and reprint requests to Hao Wu, MD, Fengzeng Jian, MD, Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, 45 Changchun St, Beijing 100053, China; E-mails: 13901397527@139.com, Fengzengjian@hotmail.com

Received 6 July, 2018

Revised 25 September, 2018

Accepted 8 November, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

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