ArticleArchives of orthopaedic and trauma surgery2023
Approach-related anatomical differences in patients with lumbo-sacral transitional vertebrae undergoing lumbar fusion surgery at level L4/5.
Article in Archives of orthopaedic and trauma surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 16 citations in OpenAlex.
- Safety in Spine Surgery: Risk Factors for Intraoperative Blood Loss and Management Strategies.Life (Basel, Switzerland) · 2025Review
- The relationship between the anatomical location of the left lumbar segmental artery and the course of the contralateral (right) segmental artery in oblique lumbar interbody fusion (OLIF): a cadaveric analysis.Journal of orthopaedic surgery and research · 2025Article
- Lateral Transpsoas Interbody Fusion.International journal of spine surgery · 2025Article
- Prevalence, diagnosis, and clinical significance of lumbosacral transitional vertebrae: A systematic review and narrative analysis.Brain & spine · 2025Review
- Relationship of the Iliac Crest Height with Subsidence After Oblique Lateral Interbody Fusion at L4-5: A Quantitative and Categorical Analysis.Journal of clinical medicine · 2024Article
- Anterior spinal fusion (ALIF/OLIF/LLIF) with lumbosacral transitional vertebra: A systematic review and proposed treatment algorithm.Brain & spine · 2023Review
- Lumbosacral Transitional Vertebrae Influence on Acetabular Orientation and Pelvic Tilt.Journal of clinical medicine · 2022Article
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionLumbo-sacral transitional vertebrae (LSTV) are accompanied by changes in soft tissue anatomy. The aim of our retrospective study was to evaluate the effects of LSTV as well as the number of free lumbar vertebrae on surgical approaches of ALIF, OLIF and LLIF at level L4/5. MATERIAL AND
methodsWe assessed the CTs of 819 patients. Of these, 53 had LSTV from which 11 had six (6LV) and 9 four free lumbar vertebrae (4LV). We matched them for sex and age to a control group.
resultsPatients with LSTV had a higher iliac crest and vena cava bifurcation, a greater distance between the common iliac veins and an anterior translation of the psoas muscle at level L4/5. In contrast, patients with 6LV had a lower iliac crest and aortic bifurcation, no differences in vena cava bifurcation and distance between the iliac veins compared to the control group.
conclusionsFor patients with LSTV and five or four free lumbar vertebrae, the LLIF approach at L4/5 may be hindered due to a high riding iliac crest as well as anterior shift of the psoas muscle. Whereas less mobilization and retraction of the iliac veins may reduce the risk of vascular injury at this segment by ALIF and OLIF. For patients with 6LV, a lower relative height of the iliac crest facilitates lateral approach during LLIF. For ALIF and OLIF, a stronger vessel retraction due to the deeper-seated vascular bifurcation is necessary during ALIF and is therefore potentially at higher risk for vascular injury.
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