Journal article
Anatomy of the diaphragmatic crura and other paraspinal structures relevant to en-bloc spondylectomy for lumbar spine tumours
- Abstract:
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Introduction
En-bloc spondylectomy in the lumbar spine is a challenging procedure mainly due to a complex prevertebral anatomy. The aim of our study is to describe the anatomy of the diaphragmatic crura and surrounding vascular and neural structures which may be iatrogenically injured during the surgical resection.
Materials and methods
Ten embalmed specimens were meticulously dissected. Widths of the diaphragmatic crura, abdominal aorta, cisterna chyli, thoracic duct, sympathetic trunks, and inferior vena cava as well as their distances from the midline were measured at nine levels (L1 to L4 vertebra and adjacent intervertebral discs).
Results
The right crus was attached to the L2–L4 vertebral bodies and L2/3 intervertebral disc, while the left crus inserted onto L1–L3 vertebrae. The thoracic duct arose commonly at the level of L2 vertebra and overlaid the right crus at the L3 vertebra and L2/3-disc levels. The cisterna chyli was present in 70% of specimens and overlapped with the left crus at the same levels. Both sympathetic trunks emerged underneath the crura at the L1/2 discs or L1 vertebra level. The aorta overlapped with the crura at all levels.
Conclusion
The L3 level appears to be the riskiest for spondylectomy due to the overlap of both diaphragmatic crura with the thoracic duct and cisterna chyli, respectively. Spondylectomy at the L2 level also brings the risk of lymphatic structures injury while injury to the left sympathetic trunk may be the main issue at the L1 level.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 1.1MB, Terms of use)
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- Publisher copy:
- 10.1007/s00586-025-08716-0
Authors
- Publisher:
- Springer
- Journal:
- European Spine Journal More from this journal
- Volume:
- 34
- Issue:
- 8
- Pages:
- 3532–3539
- Publication date:
- 2025-02-08
- Acceptance date:
- 2025-01-31
- DOI:
- EISSN:
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1432-0932
- ISSN:
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0940-6719
- Language:
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English
- Keywords:
- Pubs id:
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2084914
- Local pid:
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pubs:2084914
- Deposit date:
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2025-02-10
- ARK identifier:
Terms of use
- Copyright holder:
- Khadanovich et al.
- Copyright date:
- 2025
- Rights statement:
- © The Author(s) 2025. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
- Licence:
- CC Attribution (CC BY)
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