| Objective: Based on the magnetic resonance neurography,the imaging anatomical parameters related to oblique lumbar interbody fusion(OLIF)were measured and analyzed to provide a reference basis for preoperative evaluation and to prevent or reduce the occurrence of intraoperative and postoperative complications of OLIF.Methods:89 patients with low back pain were selected,conventional magnetic resonance sequence images and 3D COSMIC neuroimaging sequence images were obtained.The anatomical parameters of natural operation window,psoas major muscle thickness,channel placement angle,cage size,and abdominal aortic bifurcation level of L2 to L5 OLIF left approach were measured,and the risk of nerve root injury was evaluated.An unpaired t test was used to analyze the differences between sexes,One-way ANOVA or multiple independent sample rank sum test was used to compare the parameters of differences between levels,and analyze the correlation between the natural operation window and the psoas major thickness,the level of abdominal aorta bifurcation and the angle of channel insertion and the psoas major thickness.Results:Finally,a total of 83 patients were enrolled in the study,including 36 males and 47 females,and the main results were as follows:1.The average distance of natural operation window in L2 to L5 intervertebral space was(16.49±4.05)mm,(15.34±4.57)mm,and(12.12±7.34)mm;L2-3 and L4-5 and L3-4 and L4-5 were statistical significance(P < 0.05).The distance of natural operation window was negatively correlated with the thickness of psoas major muscle and positively correlated with the level of the abdominal aortic bifurcation.2.The average thickness of the left psoas major muscle increased gradually from top to bottom.The difference between men and women was statistical significance(L2-3,t=4.830,P<0.001;L3-4,t=5.931,P<0.001;L4-5,t=5.094,P<0.001);There was statistical significance among different intervertebral spaces(P <0.05).3.L3-4 channel placement Angle is the largest,which is9.17°±5.97°;The Angle of L3-4 and L4-5 in males was greater than that in females(L3-4,t=3.760,P < 0.001;L4-5,t=3.383,P=0.001);The Angle of L2-3 and L3-4 channels was positively correlated with the thickness of psoas major muscle.4.The average transverse diameter of the upper endplate of L3,L4 and L5 vertebral bodies were(50.30±3.82)mm,(53.27±3.73)mm,and(54.93±3.92)mm;5.L2-3,L3-4,the width of the L4-5 Ⅱ-Ⅲ Moro partition with mean(19.43±1.43)mm,(19.55±1.91)mm,and(19.60±1.95)mm;6.On the left side of the lumbar nerve roots are mainly distributed in zone Ⅳ of the Moro partition(50 cases in L2-3,55 cases in L3-4,and 53 cases in L4-5).7.The level of the abdominal aorta bifurcation is mainly located in the upper 1/3 of L4 vertebral body to the L4-5intervertebral space(63 cases).Conclusion:1.The 3D COSMIC neuroimaging sequence can be applied to preoperative imaging anatomical evaluation of OLIF.2.L2-3,L3-4,and L4-5 can establish the access channel related to OLIF operation,and the thickness of psoas major muscle can affect the size of the operation window and enlarge the traction range of psoas major muscle during the operation window.3.Determine the placement angle of OLIF operation and select the position of incision to provide a reference for the establishment of operation under direct vision.4.It is recommended that men choose the cage lengths of50-55 mm,women choose the cage lengths of 45-50 mm,and the width is 18-20 mm.5.The position of abdominal aorta bifurcation leads to too a small operation window,which will affect the operation of OLIF. |
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