Step-By-Step Anatomy for Anterior Approach to the Lumbar Spine: A Cadaveric Study

Abstract

Abstract Purpose: The authors meticulously described the relevant anatomy for the anterior approach to the lumbosacral spine, with a focus on critical structures at risk for surgical injuries. Methods: Using two fresh adult male cadavers, the dissections were carried out at the Toulouse anatomy department. For each specimen, a step-by-step surgical approach was followed by a broader anatomical dissection. Results: The findings were categorized into three compartments: the anterior abdominal wall, lateroretroperitoneal space, and lumbosacral prevertebral space. Each compartment was meticulously analyzed and visually described, considering both surgical and broader anatomical perspectives. Within the lumbosacral prevertebral space, the vascular anatomy emerged as the most crucial point to understand, as it helps avoid potentially fatal surgical complications for patients. Additionally, managing the ureter embedded in the posterior part of the peritoneum is critical during the lumbosacral anterior approach. Various neural structures are also encountered, with the potential for painful complications in case of injury. Conclusions: Surgeons performing the anterior lumbosacral approach must be well-versed in managing critical structures, including the peritoneum, ureter, prevertebral venous structures, and hypogastric plexus. A thorough understanding of their surgical anatomy is essential. Our surgical and broader anatomical dissections offer pragmatic visual content for surgeons practicing the anterior lumbosacral approach.