Clinical anatomy study of autonomic nerve with respective to the anterior approach lumbar surgery |
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Authors: | Sheng Lu Yong-qing Xu Shan Chang Yuan-zhi Zhang Ji-hong Shi Zi-hai Ding Zhong-hua Li and Shi-zhen Zhong |
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Institution: | (1) Department of Orthopedics, Kunming General Hospital, Chengdu Military Region, PLA, Kunming, China;(2) Department of Orthopaedics, The First Hospital of Chengdu Medical College, Chengdu, China;(3) Department of Orthopaedics, The First Hospital Affiliated to the Inner Mongolia Medical College, Hohhot, Inner Mongolia Autonomous Region, Chengdu, China;(4) The Clinical Anatomy Institute, The NanFang Medical University, Guangzhou, China |
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Abstract: | Introduction Male genital dysfunction was recognized as a complication following anterior approach lumbar surgery. Disruption of efferent
sympathetic pathways such as the abdominal aortic plexus (AAP) and superior hypogastric plexus (SHP) which lied pre-abdominal
aorta and iliac artery had been thought as the main reason. Though there were some clinical reports of retrograde ejaculation,
the applied anatomic study of the autonomic nerve anterior to the lumbar was little. The purpose was to find out a lumbar
surgery approach which was ejaculation preservation through the detailed study of the anatomy and histology observation of
the autonomic nerve anterior to the lumbar vertebrae.
Methods The lumbar region of ten male cadavers was dissected and analyzed. We investigated the relationship between the peritoneum
and abdominal aorta, iliac artery and sacral promontory fascia, as well as the trend and distribution of the autonomic nerve
and SHP anterior to the L5-S1. We also observed the distribution of autonomic nerve at retroperitoneum through hematoxylin
and eosin (HE)-stained tissues pre-aorta, para-aorta, and pre-vertebrae sacrales.
Results Superior hypogastric plexus, which deviated to left, located in a triangle formed by the common iliac arteries and its bilateral
branches, its truck sited anterior to the lumbarsacral space in seven cases (70%), and anterior to sacrum in three cases (30%);
at the aortic bifurcation, SHP strided over left iliac artery from left-hand side, then located in front of sacrum in four
cases (40%), and sifted to the left at the lumbar sacral promontory in six cases (60%); from both anatomic and histological
view, the autonomic nerve plexus lying in an fascia layer of retroperitoneum.
Conclusion At the anterior approach lumbar surgery of trans-peritoneum, we should choose the right-hand side incision; the SHP should
be pushed aside carefully from right to left along intervertebral disc. The accurate surgical plane was at the deeper layer
of autonomical nerve fascia; we also could lift the complete autonomical nerve layer which lies behind the aorta and lumbar
sacral promontory, so that the autonomic nerve could be preserved. |
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Keywords: | Lumbar The autonomic nerve Anterior approach Clinical anatomy |
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