Research on the applied anatomy of presacral space of percutaneous axial lumbosacral interbody fusion

Abstract

Objective To observe neurovascular anatomy of the presacral area, in aiming to provide Chinese anatomy data for the percutaneous axial lumbosacral interbody fusion (AxiaLIF). Methods Twenty human cadavers were investigated in our study. There were 12 males and 8 females,with an average age of 48 (range from 31 to 75years old). The distance of the presacral space from the sacral midline to the internal ilial vascular bundle, the middle sacral vascular bundle at the S1,2 level were measured. The characteristic of venous plexus of presacral region and S1 nerve roots were studied, to determine the safety space in plane. Results There were no differences between male and female in the distance of the sacral midline and bilateral vessels at the S1,2 level (P >0.05). The interval of bilateral internal iliac veins was 57.58±5.20 mm and (69.95±9.09) mm respectively. There are significant differences between male and female group (P< 0.05). The mean distance between bilateral medial margin of anterior sacral foramina was (34.95±3.50) mm and (31.98±2.99) mm in male and female respectively. The middle sacral arteries were found in all cases , but the middle sacral veins were found in 12 cases. The middle sacral arteries were found on the midline in 2 cases; on the left side in 14 cases; in right side in 4 cases. The diameter of the middle sacral arteries and middle sacral veins was measured as (0.96±0.36) mm and (2.05±0.60) mm at the S1,2 level. The Venous plexus of presacral region which formed network had found to have thin venous wall without venous valve. The S1 nerve roots was found to decline laterally after coming out of anterior sacral foramina. Conclusion In this study, we defined the coronal within the presacral space. This safe may guide surgeons when utilizing percutaneous axial lumbosacral interbody fusion (AxiaLIF). In order to ensure the saftey, the operation should be performed within the zone in fluoroscopic application. Key words: Lumbar vertebrae ; Sacrum ; Spinal fusion ; Anatomy ; regional ;