Particularities of anterior fusion in L4-L5 isthmic spondylolisthesis - 20/09/16
, C.-H. Flouzat-Lachaniette b, J. Lebhar e, G. Mirouse c, A. Poignard d, J. Allain d
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Abstract |
Purpose |
L4-L5 isthmic spondylolisthesis may be associated with lumbosacral transitional vertebrae (LSTV) and altered venous vascular anatomy. The objectives of this study were to describe the anatomical characteristics of L4-L5 ISPL and the intraoperative difficulties encountered during the approach for anterior lumbar interbody fusion (ALIF).
Methods |
This is a retrospective review of 20 ALIFs for L4-L5 ISPL. The anatomy of the common iliac veins confluence and the position of L4-L5 with respect to the projection of the iliac crest were analysed on CT-scan. Intraoperative difficulties were noted.
Results |
A LSTV was present in 60% of cases, associated with abnormally distal positioning of L4-L5 below the projection of the iliac crest. The common iliac veins confluence was abnormally proximal compared to L4-L5. No complication was noted, even if the approach was unusually difficult in 11 cases.
Discussion |
Anterior lumbotomies are difficult because the left common iliac vein courses transversely across the left anterolateral aspect of the L4-L5 disc and L5 vertebral body, increasing the risk of vascular injury. Those difficulties have led us to abandon lumbotomies to treat L4-L5 ISPL to favour a pure anterior approach (midline) or an exclusive posterior approach.
Level of evidence |
IV (retrospective study).
Le texte complet de cet article est disponible en PDF.Keywords : Spondylolisthesis, Spine, Spinal fusion, Intraoperative complications, Iliac vein, Lumbosacral region
Plan
Vol 102 - N° 6
P. 755-758 - octobre 2016 Retour au numéro
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