CLINICAL ANATOMY STUDY ON AUTONOMIC NERVES RELATED TO ANTERIOR APPROACH LUMBAR SURGERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 GUANJianzhong , CHENXianshuai , WUMin , WANGZhaodong , ZHOUJiansheng , XIAOYuzhou

Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000, P. R. China;

Corresponding?author：

GUANJianzhong, Email: jzguan2002@163.com

Keywords：

Lower lumbar anterior approach; Abdominal aortic plexus; Inferior mesenteric plexus; Superior hypogastric plexus; Applied anatomy

DOI：

10.7507/1002-1892.20140270

Video：

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Objective To understand the location characteristics of the lumbosacral autonomic nerve plexus and the morphological changes so as to provide the anatomic theoretical basis for the protection of autonomic nerve during the lower lumbar anterior approach operation. Methods A random anatomic investigation was carried out on 19 formalin-treated adult cadavers (15 males and 4 females; aged 44-78 years, mean 64 years). The anterior median line (connection of suprasternal fossa point and the midpoint of the symphysis pubis) was determined, and the characteristics of abdominal aortic plexus (AAP), inferior mesenteric plexus (IMP), and superior hypogastric plexus (SHP) were observed. The relationship between the autonomic nerve and the anterior median line was measured and recorded. Results APP and IMP were found to be located chiefly in front of the abdominal aorta in a reticular pattern, and the nerve fibers of the two nerve plexuses were more densely at the left side of abdominal aorta than at the right side. Superior hypogastric plexus showed more distinct main vessel variations, including 4 types. The main vessel length of the SHP was (59.38±12.86) mm, and the width was (11.25±2.92) mm. The main vessels of SHP were mainly located at the left side of the ventral median line (10, 52.6%) and anterior lumbar vertebra (13, 68.4%). The main vessels extended down to form the left and right hypogastric nerves. Conclusion It is applicable to expose the nerve from the right side of centrum and move the autonomic nerve and blood vessel as a whole during anterior lower lumbar operation. In this way, the dissection to separate nerve plexus is not needed, thus nerve injury can be avoided to the largest extent.

Citation： GUANJianzhong, CHENXianshuai, WUMin, WANGZhaodong, ZHOUJiansheng, XIAOYuzhou. CLINICAL ANATOMY STUDY ON AUTONOMIC NERVES RELATED TO ANTERIOR APPROACH LUMBAR SURGERY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1248-1252. doi: 10.7507/1002-1892.20140270 Copy

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2.	Fantini GA, Pawar AY.Access related complications during anterior exposure of the lumbar spine.World J Orthop, 2013, 4(1):19-23.
3.	Garg J, Woo K, Hirsch J, et al.Vascular complications of exposure for anterior lumbar interbody fusion.J Vasc Surg, 2010, 51(4):946-950.
4.	Kasliwal MK, Deutsch H.Anhidrosis after anterior retroperitoneal approach for L4-L5 artificial disc replacement.J Clin Neurosci, 2011, 18(7):990-991.
5.	謝加興, 劉金偉, 陳啟康, 等.上腹下叢的應用解剖及臨床意義.解剖學研究, 2009, 31(5):371-373.
6.	Paraskevas G, Tsitsopoulos P, Papaziogas B, et al.Variability in superior hypogastric plexus morphology and its clinical applications:a cadaveric study.Surg Radiol Anat, 2008, 30(6):481-488.
7.	陸聲.腰椎前路微創手術及椎體成形術的相關應用解剖、生物力學及臨床應用研究.廣州:第一軍醫大學, 2006.
8.	姜建元.脊柱應用解剖圖譜.北京:人民軍醫出版社, 2007:185.
9.	Brau SA.Mini-open approach to the spine for anterior lumbar interbody fusion:description of the procedure, results and complications.Spine J, 2002, 2(3):216-223.
10.	荊玨華, 錢軍, 田大勝, 等.應用腹腔鏡行下腰椎手術的入路選擇.臨床骨科雜志, 2011, 14(1):83-85.
11.	Regan JJ, McAfee PC, Guyer RD, et al.Laparoscopic fusion of the lumbar spine in a multicenter series of the first 34 consecutive patients.Surg Laparosc Endosc, 1996, 6(6):459-468.
12.	凌云志, 劉振華, 周建生, 等.腰骶椎前路手術"有效工作區"血管應用解剖學研究.蚌埠醫學院學報, 2009, 34(2):110-114.
13.	Edgard-Rosa G, Geneste G, Nègre G, et al.Midline anterior approach from the right side to the lumbar spine for interbody fusion and total disc replacement:a new mobilization technique of the vena cava.Spine (Phlia Pa 1976), 2012, 37(9):E562-569.
14.	Asha MJ, Choksey MS, Shad A, et al.The role of the vascular surgeon in anterior lumbar spine surgery.Br J Neurosurg, 2012, 26(4):499-503.
15.	Jarrett CD, Heller JG, Tsai L.Anterior exposure of the lumbar spine with and without an "access surgeon":morbidity analysis of 265 consecutive cases.J Spinal Disord Tech, 2009, 22(8):559-564.

1. Vialle R, Rillardon L, Feydy A, et al.Spinal trauma with a complete anterior vertebral body dislocation:a report of three cases.Spinal Cord, 2008, 46(2):154-158.
2. Fantini GA, Pawar AY.Access related complications during anterior exposure of the lumbar spine.World J Orthop, 2013, 4(1):19-23.
3. Garg J, Woo K, Hirsch J, et al.Vascular complications of exposure for anterior lumbar interbody fusion.J Vasc Surg, 2010, 51(4):946-950.
4. Kasliwal MK, Deutsch H.Anhidrosis after anterior retroperitoneal approach for L4-L5 artificial disc replacement.J Clin Neurosci, 2011, 18(7):990-991.
5. 謝加興, 劉金偉, 陳啟康, 等.上腹下叢的應用解剖及臨床意義.解剖學研究, 2009, 31(5):371-373.
6. Paraskevas G, Tsitsopoulos P, Papaziogas B, et al.Variability in superior hypogastric plexus morphology and its clinical applications:a cadaveric study.Surg Radiol Anat, 2008, 30(6):481-488.
7. 陸聲.腰椎前路微創手術及椎體成形術的相關應用解剖、生物力學及臨床應用研究.廣州:第一軍醫大學, 2006.
8. 姜建元.脊柱應用解剖圖譜.北京:人民軍醫出版社, 2007:185.
9. Brau SA.Mini-open approach to the spine for anterior lumbar interbody fusion:description of the procedure, results and complications.Spine J, 2002, 2(3):216-223.
10. 荊玨華, 錢軍, 田大勝, 等.應用腹腔鏡行下腰椎手術的入路選擇.臨床骨科雜志, 2011, 14(1):83-85.
11. Regan JJ, McAfee PC, Guyer RD, et al.Laparoscopic fusion of the lumbar spine in a multicenter series of the first 34 consecutive patients.Surg Laparosc Endosc, 1996, 6(6):459-468.
12. 凌云志, 劉振華, 周建生, 等.腰骶椎前路手術"有效工作區"血管應用解剖學研究.蚌埠醫學院學報, 2009, 34(2):110-114.
13. Edgard-Rosa G, Geneste G, Nègre G, et al.Midline anterior approach from the right side to the lumbar spine for interbody fusion and total disc replacement:a new mobilization technique of the vena cava.Spine (Phlia Pa 1976), 2012, 37(9):E562-569.
14. Asha MJ, Choksey MS, Shad A, et al.The role of the vascular surgeon in anterior lumbar spine surgery.Br J Neurosurg, 2012, 26(4):499-503.
15. Jarrett CD, Heller JG, Tsai L.Anterior exposure of the lumbar spine with and without an "access surgeon":morbidity analysis of 265 consecutive cases.J Spinal Disord Tech, 2009, 22(8):559-564.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL ANATOMY STUDY ON AUTONOMIC NERVES RELATED TO ANTERIOR APPROACH LUMBAR SURGERY

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