Neuroanatomical analysis of L5/S1 segments anterior lumbar interbody fusion
Objective To observe the lumbar autonomic nerves on the ventral side of the L5 to S1,thereby providing neuroanatomical data for L5/S1 segments anterior lumbar surgery.Methods Ten adult lumbosacral specimens were used for anatomical observation,the abdominal visceral organs were carefully removed,the lumbar autonomic nerves on the ventral side of the L5 to S1 were separated under the microscope,and its anatomical features including morphology,course and distribution were observed.The length of the superior hypogastric plexus,the distances between its right margin and the median abdominal line on the L5 inferior endplate level(D2)and S1 superior endplate level(D3),the distances between the right margin of superior hypogastric plexus and the right common/internal iliac artery on the L5 inferior endplate level(D4)and the right internal iliac artery on the S1 superior endplate level(D5),and the distance between its rightmost margin and the median abdominal line(D6)were measured using a vernier caliper accurate to 0.01 mm.Results The superior hypogastric plexus was formed by the abdominal aortic plexus,the inferior mesenteric plexus,and the 3rd and 4th lumbar splanchnic nerves,which was mainly distributed on the ventral side of the L5/S1 intervertebral space,with(59.10±5.31)mm of its main trunk length.D2 was(3.72±3.09)mm on the left side of the abdominal midline,D3 was(1.79±6.00)mm on the right side of the abdominal midline,D6 was(4.74±5.60)mm on the right side of the abdominal midline,and there were statistically significant differences between D2 and D3(F=6.666,P=0.019),and D2 and D6(F=17.502,P=0.010),but there was no statistical difference between D3 and D6(F=1.296,P=0.270).D4 was(17.42±6.99)mm,D5 was(20.58±9.01)mm,and there was no statistical difference between them(F=0.767,P=0.393).There was no statistically significant difference in the above data between different genders(P>0.05).Conclusion On the L5/S1 intervertebral disc level,the right common/internal iliac artery gradually moves towards the lateral side of median abdominal line,thus increasing its distance from the superior hypogastric plexus.The distance between the right margin of the superior hypogastric plexus and the right common/internal iliac artery is significantly greater than its distance from the median abdominal line,and there is an extremely small amount of lumbar autonomic nerve fibers between the right common/internal iliac artery and the median abdominal line.
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