J Korean Neurosurg Soc.  2023 Mar;66(2):155-161. 10.3340/jkns.2022.0079.

Morphometric Analysis of the Ureter with Respect to Lateral Lumbar Interbody Fusion Using Contrast-Enhanced Computed Tomography

• Huang C
• Bian Z
• Zhu L

• KMID: 2539876
• DOI: http://doi.org/10.3340/jkns.2022.0079

Abstract

Objective
: To analyze the anatomical location of the ureter in relation to lateral lumbar interbody fusion and evaluate the potential risk of ureteral injury.
Methods
: One hundred eight patients who performed contrast-enhanced computed tomographic scans were enrolled in this study. The location of the ureter from L2-L3 to L4-L5 was evaluated. The distances between the ureter and psoas muscle, intervertebral disc, and retroperitoneal vessels were also recorded bilaterally.
Results
: Over 30% of the ureters were close to the working corridor of extreme lumbar interbody fusion at L2-L3. Most of the ureters were close to working corridor of oblique lumbar interbody fusion, especially at L4-L5. The distance from the ureter to the great vessels on the left side was significantly narrowing from L2-L3 to L4-L5 (28.8±9.5 mm, 22.0±8.0 mm, 15.5±8.4 mm), and it was significantly larger than that on the right side (12.3±6.1 mm, 7.4±5.7 mm, 5.4±4.4 mm).
Conclusion
: Our findings indicate that the location of the ureter varies widely among individuals. To avoid unexpected damage to the ureter, it is imperative to directly visualize it and verify the ureter is not in the surgical pathway during lateral lumbar interbody fusion.

Keyword

Lateral lumbar interbody fusion; Extreme lumbar interbody fusion; Oblique lumbar interbody fusion; Ureteral injury; Complication

Figure

• 

  Fig. 1. Evaluation of anatomical location of the ureter from contrast-enhanced computed tomography images. A : The axial plane of intervertebral discs was divided into four zones. B : The psoas area was also divided into four zones. C : Measurements of relevant parameters, ureter-vessel distance (UVD), ureter-psoas distance (UPD), and ureter-disc distance (UDD), at L2-L3, L3-L4, and L4-L5. Red line : UVD; blue line : UPD; yellow line : UDD.

• 

  Fig. 2. Location of the ureter in the disc and psoas area. A : Location of the ureter on the left side according to the disc area classification. B : Location of the ureter on the right side according to the disc area classification. C : Location of the ureter on the left side according to the psoas area classification. D : Location of the ureter on the right side according to the psoas area classification. K : within kidney.

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  Fig. 3. The correlation between UVD and psoas dimensions on the left side. Disc levels of L2-L3 (A-C), L3-L4 (D-F), L4-5 (G-I). The lines were based on the linear regression with Pearson’s correlation coefficient. UVD : ureter-vessel distance, AP : antero-posterior, ratio : psoas AP dimension : lateral dimension.

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  Fig. 4. The correlation between UVD and psoas dimensions on the right side. Disc levels of L2-L3 (A-C), L3-L4 (D-F), L4-5 (G-I). The lines were based on the linear regression with Pearson’s correlation coefficient. UVD : ureter-vessel distance; AP : antero-posterior; ratio : psoas AP dimension : lateral dimension.

Reference

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