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Introduction: Lateral lumbar interbody fusion (LLIF) is becoming a more common surgical treatment option for adult degenerative lumbar conditions. LLIF is a mini-open access technique with wound retractors, and postoperative hematoma due to segmental vessels injury is reported. Thus, it is considered that there is a need to conduct detailed preoperative examinations to identify where the lumbar vessels are. As far as we know, there are only a few studies investigating the location of the lumbar arteries. This study evaluates the anatomical position of lumbar arteries using magnetic resonance imaging (MRI). Methods: We studied 101 MRIs of patients with lumbar disease. The length from the upper and lower end plates of the vertebra to the lumbar arteries was measured. The measurement was conducted with coronal MRI images of every quarter slice of L1 to L4 vertebrae. We also investigated sagittal MRI images to determine whether the lumbar vessels are located on intervertebral disc in each level from L1/2 to L5/S1. Results: The lumbar vessels are not always located at the center of the vertebrae. Some lumbar vessels are located within 8 mm from the end plates. Especially in L4, the lumbar vessels tended to go down from the anterior cranial side to the posterior caudal side (P < 0.01). 8, 24, and 54 lumbar vessels are located at the anterior quarter, the center, and the posterior quarter slice of the vertebrae, respectively, in L4. There were seven lumbar vessels in total located on the vertebral disc level. Conclusions: It is necessary to investigate where the lumbar arteries are located to prevent its injury in LLIF, because the lumbar artery is not always located at the center of a vertebra. MRIs may provide a valuable information to avoid vascular injury during LLIF.

IntroductionSurgical site infections (SSIs) with methicillin-resistant Staphylococcus aureus are serious complications of spinal instrumentation surgery. Many spine surgeons are concerned that using prophylactic vancomycin powder will lead to certain risks: the development of multidrug-resistant pathogens, anaphylactic reactions, and organ toxicity. Minimally invasive spine stabilization (MISt) is associated with shorter operation times and less blood loss and may therefore require the use of less vancomycin powder, which may reduce these risks. This retrospective comparative study of patients who underwent MISt at a single institution aimed to evaluate the complications (such as allergy, SSIs, and organ toxicity) and the local and serum levels associated with using prophylactic intrawound vancomycin powder compared with IV cefazolin alone. MethodsThirty-four patients received intrawound vancomycin powder (1 g) applied during wound closure in minimally invasive posterior lumbar interbody fusion (MIS-PLIF). This group was compared with 133 control patients who did not receive vancomycin. White blood cell counts and C-reactive protein (CRP) levels were measured for both groups on postoperative days (PODs) 1, 3, and 7 and were statistically analyzed. In the vancomycin group, serum vancomycin levels were measured on PODs 1, 3, 7, and 14; drain vancomycin levels and postoperative blood loss were determined on PODs 1 and 2. ResultsThe CRP levels on PODs 1 and 3 were significantly higher in the vancomycin group than in the control group (P<0.001, P=0.024). In the vancomycin group, mean drain levels trended downward from 313 μg/mL (POD 1) to 155 μg/mL (POD 2). These levels correlated negatively with drain drainage volume on both days (POD 1: r=-0.48, P=0.015; POD 2: r=-0.47, P=0.019). Mean serum vancomycin levels also trended downward from 2.3 μg/mL (POD 1) to 1.7 μg/mL (POD 14). ConclusionsOur results unexpectedly demonstrated that the local application of vancomycin powder causes an acute inflammatory response and the long-term detection of low serum vancomycin levels. Less than 1 g of intrawound vancomycin powder may be useful only at high risk of SSI.

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