Lumbar Sympathetic Chain Tract and Mobility of Oblique Lumbar Interbody Fusion Approach: A Cadaveric Study

Abstract

To assess lumbar sympathetic chain (LSC) relation to the surgical corridor for oblique lumbar approach and the ability to mobilize the LSC. Forty-three cadavers were included. Left-sided anterior retroperitoneal approach was performed in a supine position. Distance between the great vessels and psoas muscle (oblique corridor) and distance between great vessels and LSC at L2/3, L3/4, and L4/5 disc levels were measured. Mobilization of LSC at each disc level was done either close to or away from the psoas muscle and each mobilization distance was measured. The presence rates of LSC in oblique corridor were 19.5%, 43%, and 75.7% at L2/3, L3/4, and L4/5 levels, respectively. At L2/3 disc level, mean distance between psoas muscle and LSC and its mobility were 0.61±1.31 mm, and 2.72±1.24 mm, respectively. At L3/4 disc level, mean distance between psoas muscle and LSC and its mobility were 1.72±2.53 mm, and 3.11±1.02 mm, respectively. At L4/5 disc level, mean distance between psoas muscle and LSC and its mobility were 2.94±3.52 mm, and 2.53±1.03 mm, respectively. The mean width of corridor of L2/3, L3/4, and L4/5 were 10.73±5.82, 12.63±5.02, and 15.43±6.31 mm, respectively. The LSC tract usually lies in the oblique corridor in L4/5 but keeps decreasing in prevalence when approaching L3/4 and L2/3 levels. It can be mobilized a few millimeters close to or away from the psoas muscle. Care should be taken to prevent LSC injury, particularly when the LSC needs to be retracted along with the psoas muscle.