Bilgisayarlı tomografi anjiyoda, posterior disk cerrahisinde önemli vasküler yapıların morfometrik analizi

Morphometric analysis of significant vascular structures in posterior disc surgery with computed tomography angiography

Özet

AMAÇ: Lomber disk cerrahisi başta olmak üzere spinal bölgeye yönelik tüm prosedürlerde damar yaralanmaları nadir görülmekle birlikte hayati öneme sahiptir. Biz çalışmamızda abdominal aortaya yönelik bilgisayarlı tomografi anjiyo (BTA) çekilen hastalarda iliak arter ve venin seyrini, intervertebral disk mesafeleri ile olan ilişkilerini morfometrik olarak araştırdık. GEREÇ VE YÖNTEM: Bu çalışma geriye dönük olarak yapıldı. Herhangi bir nedenle BTA çekilen 100 hasta çalışmaya alındı. Hastaların BTA incelemelerinde aort bifurkasyonu (AB), sağ ve sol kommon iliak arter (R/LCIA) ve ven (R/LCIV), kommon iliak arter bifurkasyonunun (CIAB) lokalizasyonu araştırıldı. Bu vasküler yapıların spinal vertebra body (VB) ve interverteral disk seviyesinde (IDL) lokalizasyonu, anterior longitudinal ligaman (ALL) ile aralarında yağ plan olup olmadığı araştırıldı. BULGULAR: L4-5 IDL’de RCIA %51 saat 12 hizasında ve %67 oranında ALL ile arasında RCIV bulunmaktaydı. LCIA %72 saat 1 hizasında ve %47 ALL’ye yapışık, %11 arada yağ planı mevcut iken %14 arada LCIV bulunmaktaydı. RCIV %92 saat 11 hizasında yerleşmekte, %97 ALL ile arasında yağ plan bulunmamaktaydı. LCIV %80 saat 11-12 hizasında, %18 transvers olarak saat 12-1-2 boyunca yerleşmekte ve hastaların tümünde ALL ile arasında yağ plan bulunmamakta, ALL’ye yakın yerleşimliydi. LCIA L4-5 IDL ALL’ye RCIA göre daha uzaktır (p

Abstract

BACKGROUND: Vascular injuries, which are rarely seen in all spinal area procedures, especially lumbar disc surgery, are vitallyimportant. The relationship between the course of the iliac artery and vein and intervertebral disc distance was studied morphometrically in patients who had undergone computed tomography angiography for abdominal aorta.METHODS: This study was carried out retrospectively. A total of 100 patients who had undergone computed tomography angiographyparticipated in the study. The aorta bifurcation, right and left common iliac artery (R/LCIA) and vein (R/LCIV), and the location of thecommon iliac artery bifurcation were investigated. The location of these vascular structures at the level of the spinal vertebral body andat the intervertebral disc level, determination of a fat plane between them, and the anterior longitudinal ligament (ALL) were analyzed.RESULTS: At the L4-5 intertransversarius dorsalis (IDL), the RCIV was determined to be at the 12 o’clock position RCIA in 51% ofcases and between the ratio of 67% ALL. The LCIA was at the 1 o’clock position in 72% and adjacent to the ALL in 47%. The RCIV waslocated in the 11 o’clock position and there was no fat plane between the RCIV and the ALL in 92%. In 80%, the LCIV was located at the11-12 o’clock position and in 18% transversely along the 12-1-2 o’clock region. There was no fat plane between the LCIV and the ALL inany patient. At the L5-S1 IDL, the RCIA was observed at the 10 o’clock position in 63%, and there was no fat plane between the RCIAand the ALL. The LCIA was at the 2 o’clock position in 72% and the LCIV was between the ALL and the LCIA in 92%. The RCIV waslocated at the 9-10 o’clock position in 95% and no fat plane was found between the ALL and the RCIV in 60%. The LCIV was locatedat the 1-2 o’clock position in 96% and there was no fat plane between the LCIV and the ALL in 92%; it was located close to the ALL.CONCLUSION: The L4-5 IDL RCIA was located at the midline and at a 30° angle position. The LCIV was located between them.The L5-S1 IDL located at LCIA left at 60° position was quite close to ALL with LCIV. When the distance from the ALL was compared and the frequency of fat planes between the ALL and the CIAs are considered, it can be noted that the RCIA in the L4-L5 IDL(p