The Imaging Anatomy Study Of Zhuang Population Using The Transpsoas Extreme Lateral Interbody Fusion

Objective:to determine anatomical position of lumbar plexus and major abdominal blood vessels in relation to the vertebral body and anterior edge of psoas muscle, and define the safe working zone using the transpsoas lumbar interbody fusion, choose the appropriate operative approach when using the transpsoas lumbar interbody fusion(XLIF), avoid damaging the lumbar plexus and major blood vessels.Methods:We retrospectively evaluated lumbar spine MRI at 100 patients (from L1-L2 to L4-L5). The total number of lumbar vertebrae measured was 342 levels. Relevant parameters were measured from axial magnetic resonance images and analyzed, including the psoas muscle and vertebrae endplate diameters, the overlap between anterior border of the ventral nerve roots and the anterior border of the psoas muscle, the overlap between the anterior border of the ventral nerve roots and the posterior border of the endplate of the vertebral body, the overlap between anterior border of the retroperitoneal vessels and the posterior border of the psoas muscle, the overlap between the posterior border of the retroperitoneal vessels and the anterior border of the vertebral body, the angle of the retroperitoneal vessels. The safe working zone(SWZ) was defined as the relative endplate vertebral body sagittal diameter that is the overlap between anterior border of the nerve root and the anterior border of the retroperitoneal vessels.Results:the left safe working zone was 35.59mm(4.00) at L1-L2,36.44 mm (3.74) at L2-L3,35.68 mm (3.79) at L3-L4,30.79 mm (5.33) at L4-L5, and the right safe working zone is 33.39 mm (6.93) at L1-L2,31.33 mm (5.47) at L2-L3,30.43mm (4.85) at L3-L4,26.00 mm (4.75) at L4-L5.The safe working zone between L1-L2,L2-L3, L3-L4 level has not significant difference, the safe working zone has a significant reduction at L4-L5 level. The right SWZ is significant smaller than the left SWZ at the same level. Compare with the SWZ of male, the SWZ of female is smaller.Conclusions:1.The left side and right side are suitable for the Zhuang population using transpsoas lumbar interbody fusion.2.The SWZ of transpsoas lumbar interbody fusion from L1-L2 to L3-L4 has not significant difference, the SWZ of L4-L5 level is significant smaller than the SWZ at L3-L4 level.3. The right SWZ is significant smaller than the left SWZ; the SWZ of female is smaller than that of male.4.The puncture point of the Zhuang population using XLIF lies in zone Ⅱ and zone Ⅲ at L1-L2,L4-L5level(zone Ⅲ at L2-L3,L3-L4level)...