Evidence map›Paper›PMID 42053793›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026

Level-specific relative safe areas and critical vascular zones in the left-sided approach to the thoracic and lumbar spine: an anatomical human cadaver study.

Vincent J Heck, Franziska Conrad, Margarethe Draga, Juan Manuel Vinas-Rios, Tobias Prasse, Maximilian Weber, Martin Scaal, Peer Eysel, Stavros Oikonomidis

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Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Vincent J HeckFaculty of Medicine and University Hospital Cologne, Department of Orthopedics, Trauma Surgery and Plastic-Aesthetic Surgery, University of Cologne, Cologne, Germany. vincent.heck@uk-koeln.de.
Franziska ConradFaculty of Medicine and University Hospital Cologne, Department of Orthopedics, Trauma Surgery and Plastic-Aesthetic Surgery, University of Cologne, Cologne, Germany.
Margarethe DragaFaculty of Medicine and University Hospital Cologne, Center of Anatomy, University of Cologne, Cologne, Germany.
Juan Manuel Vinas-RiosFaculty of Medicine, Autonomous University of San Luis Potosí, San Luis Potosí City, Mexico.
Tobias PrasseFaculty of Medicine and University Hospital Cologne, Department of Orthopedics, Trauma Surgery and Plastic-Aesthetic Surgery, University of Cologne, Cologne, Germany.
Maximilian WeberFaculty of Medicine and University Hospital Cologne, Department of Orthopedics, Trauma Surgery and Plastic-Aesthetic Surgery, University of Cologne, Cologne, Germany.
Martin ScaalFaculty of Medicine and University Hospital Cologne, Center of Anatomy, University of Cologne, Cologne, Germany.
Peer EyselFaculty of Medicine and University Hospital Cologne, Department of Orthopedics, Trauma Surgery and Plastic-Aesthetic Surgery, University of Cologne, Cologne, Germany.
Stavros OikonomidisFaculty of Medicine and University Hospital Cologne, Department of Orthopedics, Trauma Surgery and Plastic-Aesthetic Surgery, University of Cologne, Cologne, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis anatomical study aimed to define relative level-specific safe areas and critical vascular zones for left-sided ventral approaches to the thoracic and lumbar spine.

methodsThirty-two formalin-fixed cadavers (16 females, 16 males; mean age 85 years) were included. Lumbar and thoracic segmental arteries and veins between T5 and L3 were identified and their localization documented in detail by dividing each vertebral body into cranial, middle, and caudal thirds, as well as anterior and posterior halves. Adjacent intervertebral discs were included. Vessel courses, variations, and the relation to the hemiazygos vein and the artery of Adamkiewicz were systematically recorded.

resultsNo vertebral region was consistently free of vessels. Arterial distribution differed between thoracic and lumbar levels, with T12 demonstrating a transitional pattern between these regions. In the thoracic spine, the cranial third of the vertebral body and the caudal half of adjacent discs showed the lowest arterial density (< 15%), representing regions of comparatively low vascular density. Venous variability was higher in anterior than in posterior vertebral halves. At T12 and in the lumbar spine, the lowest arterial density occurred at the disc level. Critical vascular zones included the caudal third of T5-T11 and the middle third of T12 and below. The artery of Adamkiewicz was macroscopically identified in 16% of the cases.

conclusionSegmental vascular anatomy is highly variable. Level-specific mapping of arteries and veins enables the identification of relative safe areas and critical vascular zones to improve safety during anterior and lateral thoracolumbar approaches.

Indexed as

Critical vascular zoneLeft-sided approachSafe areaSpine surgeryThoracolumbar spine

Identifiers

PMID42053793

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.