Step by step teaching anatomy for anterior approach of the lumbar spine: A cadaveric study.

PURPOSE: The authors described detailed relevant anatomy for anterior approach of the lumbosacral spine emphasizing all critical structures at risk for surgical injuries.

METHODS

Two fresh adult male cadavers were dissected at the Toulouse anatomy department. For each specimen, a step-by-step surgical approach followed by broader anatomical dissection was performed.

RESULTS

Results were divided into three compartments: anterior abdominal wall, latero/retroperitoneal space, lumbosacral prevertebral space. Each compartment was analyzed and visually described according to surgical and wider anatomical approach. Each region has critical anatomical structures that need to be well managed during surgery avoiding surgical complications. In the lumbosacral prevertebral space, the vascular anatomy is the most critical point to know to avoid potentially fatal surgical complications for patients. Ureter embedded into the posterior part of the peritoneum is also a critical structure to manage correctly during lumbosacral anterior approach. Different neural structures are also encountered with potential painful complications in case of injury.

CONCLUSIONS

In reference to anterior lumbosacral approach, critical structures to manage are peritoneum, ureter, prevertebral venous structures and hypogastric plexus. Their surgical anatomy has to be known and well recognized during surgery. Our surgical then broader anatomical dissections provide pragmatic pictural pedagogic content for teaching surgeons practicing anterior lumbosacral approach.