Anatomical variations of the iliolumbar vein with application to the anterior retroperitoneal approach to the lumbar spine: A cadaver study

Abstract

Objectives of this study include identification of lumbosacral venous variations, designation of a critical area of dissection for surgical exposure, and comparison between both male/female and right/left-sided anatomy. Attempts were made to provide anatomic nomenclature that accurately describes these structures. Thirty-eight iliolumbar venous systems in 20 cadavers (11 females/9 males) were dissected. Each system was identified as one of three patterns of variation: common venous trunk (combining ascending lumbar and iliolumbar venous systems) with distal veins, common venous trunk without distal veins, and venous systems without a common venous trunk. Dimensions including distances to the inferior vena cava (IVC) confluence, the obturator nerve, and the lumbosacral trunk, and venous stem length were obtained to aid surgical dissection. Differences between males and females and those between right and left sides were compared. Anterior lumbosacral venous variations could be organized into three groups. A Type 1 venous system (common venous trunk with distal veins) was most common (53% of systems). The anatomical name "lateral lumbosacral veins" adequately describes the anatomical location of these veins and does not assume a direction of venous flow or the lack of individual distal veins. A critical area bordered by the obturator nerve anteriorly, the psoas muscle laterally, the spinal column medially, and sacrum posteriorly within 8.2 cm of the IVC confluence should be defined to adequately dissect the lateral lumbosacral veins. Differences in male and female lateral lumbosacral venous anatomy do not alter surgeon's approach to the anterior lumbar spine.

The collateral venous system in late pregnancy: A systematic review of the literature

“…They proposed that this was due to the larger size of the female pelvis (Sivakumar et al, ). Unruh et al () noted that the common trunk, when present, was longer in males (mean 1.5 cm) than females (mean 1.2 cm).…”

“…The patterns of insertion are variable and are not always symmetrical between left and right sides. Only two studies found significant gender differences in the origin of the ALV (Sivakumar et al, ; Unruh, et al, ). Sivakumar et al () reported a difference in the distance from the formation of the IVC to the origin of the ALV, with females having a mean distance of 4.2 cm and males 3.0 cm.…”

“…The presence of valves in the ALV could affect the normal physiological direction of blood flow and the collateral circulation in the event of IVC obstruction. In addition, only a few studies have provided information regarding anatomical differences between genders, none of which studied the ALV in its entirety (Sivakumar et al, ; Unruh et al, ).…”

Morphometric anatomy of the lumbar sympathetic trunk with respect to the anterolateral approach to lumbar interbody fusion: a cadaver study

“…Typically seen mid body of L5, occasionally the authors have noted the iliolumbar vein to cross the disc space. One cadaveric study (33) found that 5% of LLSVs ran superficial to the obturator nerve whereas 66.6% ran superficial to the LST. The common iliac and both iliac arteries frequently become tortuous with age, and thus have variable position , passing anterior in 70% of cases and posterior to the obturator nerve in 30% of cases in one cadaveric study (34).…”

A Surgical Option for Multilevel Anterior Lumbar Interbody Fusion with Ponte Osteotomy to Achieve Optimal Lumbar Lordosis and Sagittal Balance

“…While complications of AILF may be more numerous when compared with the posterior spine surgical procedures recent efforts by many surgeons have been aimed at avoiding complications and have yielded many articles regarding safer techniques and have revealed intra-abdominal improved surgical approach8,9,24). Consequently, ALIF is a less demanding and dangerous procedure.…”