Relationship of aortic bifurcation with sacropelvic anatomy: Application to anterior lumbar interbody fusion

Abstract

Introduction Various sacropelvic parameters such as the pelvic Incidence (PI) are used to predict ideal lumbar lordosis and aid surgical planning. The objective of this study was to establish the relationship between the location of the aortic bifurcation from the sacral promontory and sacropelvic measures including the PI. Materials and Methods One hundred sixty five computed tomography (CT) scans obtained for major trauma including the entire spine were identified. Sacropelvic parameters including PI, sacral anatomic orientation, pelvic thickness (PTH), and sacral table angle were measured. Aortic bifurcation was identified on sagittal and coronal imaging and the distance from the sacral promontory (bifurcation‐promontory distance [BPD]) measured (mm). Results Mean age of the cohort was 44.3 years (SD 18.5; range 16–88 years); 61.8% male. The mean PI was 49.2° (SD 10.2°; range 30°–80°). The mean BPD was 66.4 mm (SD 13.1 mm; range 38.3–100 mm). In the majority, the bifurcation was at the level of the L4 vertebral body (72.7%). Only age (r = −.389; p < .0001) and PTH (r = .172; p = .027) correlated with the BPD to a significant degree. PI did not correlate with BPD (r = .061; p = .435). Linear regression analysis provided the following predictive equation: BPD = 34.3 mm + 0.30 × PTH. Conclusion This study demonstrates a lack of any meaningful correlation between sagittal pelvic parameters and the distance of the aortic bifurcation from the sacral promontory. Surgical planning for fusion surgery in the lumbar spine should include assessment of spinopelvic parameters and if anterior access to the lumbar disc(s) necessary, vascular anatomy should be carefully assessed independent of these measures.

Sacropelvic Parameters and L5 Spondylolysis: Computed Tomography Analysis

“…CT obtained for the assessment of blunt or major trauma has been used previously to analyze sacropelvic measures. It is reassuring that this report’s findings are similar to those reported elsewhere, providing this technique’s validity [ 7 , 21 , 29 ]. Moreover, it was not determined whether a patient had spinal symptoms or symptoms attributable to spondylolysis.…”

Lumbar Interbody Fusion and Osteobiologics for Lumbar Fusion

“…A careful review of the vascular structures along with the lumbar spine by preoperative magnetic resonance imaging (MRI) and/ or computed tomography scan is recommended to assess the region of interest (Fig. 3) [59][60][61]. Generally, the retroperitoneal approach is preferred, because transperitoneal access is associated with high rates of ileus, internal organ injury, and retrograde ejaculation and is restricted in the L5-S1 segment.…”

Is there a variance in complication types associated with ALIF approaches? A systematic review

“…The ALIF approach at L4/L5 is limited by the rates of vascular injury and degree of vessel mobilisation required [73]. Research has failed to demonstrate a predictive correlation between anatomical pelvic parameters and overlying vessel location, indicating independent vascular planning may be required in the surgical approach [4]. Chiriano et al [17] found vascular injuries occurred most commonly during the L4/L5 approach during exposure between the left iliac artery and vein resulting in a significantly higher rate injury (p < 0.001), echoed by two studies in this review [26,46], with Manunga et al [46] finding 84.6% vessel injuries occurring at the L4/L5 exposure step using an open approach, most commonly due to avulsion of the iliac vessels.…”