Applied anatomy of presacral approach for axial lumbar interbody fusion
LI Xiang-Ming, ZHANG Yu-Song, HOU Zhi-Dian, WU Tao, DING Zi-Hai
Chinese Journal of Clinical Anatomy ›› 2011, Vol. 29 ›› Issue (1) : 34-38.
Applied anatomy of presacral approach for axial lumbar interbody fusion
Objective The aim of this study was to evaluate the safety of the presacral approach for axial lumbar interbody fusion. Methods (1) The pelvic region of 12 adult cadavers was dissected and analyzed. All specimens were divided in the median sagittal plane. The main goal of these dissection was to understand the fascial structures of the presacral space and measure some data correlated with the rectosacral fascia and pelvic splanchnic nerves. (2) The blunt guide pin was inserted using the technique described by Marotta into 24 pelvic-halves, the distance from the trocar to important structures in the presacral space was measured. Results (1) The fascial structures of the presacral space was multilaminar, it could be divided into five levels. (2) The rectosacral fascia was found in 11 out of 12 specimens（91.7%），it originated from the parietal presacral fascia at the level of S2 in16.7% ,S3 in 41.7% and S4 in 33.3%. The presacral space was divided into superior and inferior portions by the rectosacral fascia. (3) Pelvic splanchnic nerves confined the dissection of the lower rectum, its length which could be used as a measure of the'sagittal safe zone' for presacral space was（22.9±3.2）mm. (4) In this study, the shortest distance from the guide pin to pelvic splanchnic nerves was （7.8±1.9）mm, the vertical distance to the S3/4 junction was（15.0±3.6）mm. Conclusion It is risky to perform the presacral approach for axial lumbar interbody fusion because of the presence of the rectosacral fascia, presacral venous plexus and the vascular variations.
Interbody fusion / Presacral space / Surgical plane / Pelvic splanchinc nerves / Applied anatomy
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