European Spine Journal

, Volume 20, Issue 4, pp 557–562 | Cite as

An MRI study of psoas major and abdominal large vessels with respect to the X/DLIF approach

  • Wan-Kun Hu
  • Shi-Sheng HeEmail author
  • Shao-Cheng Zhang
  • Yan-Bin Liu
  • Ming Li
  • Tie-Sheng Hou
  • Xiao-Lu Ma
  • Jian Wang
Original Article


Extreme/direct lateral interbody fusion (X/DLIF) has been used to treat various lumbar diseases. However, it involves risks to injure the lumbar plexus and abdominal large vessels when it gains access to the lumbar spine via lateral approach that passes through the retroperitoneal fat and psoas major muscle. This study was aimed to determine the distribution of psoas major and abdominal large vessels at lumbar intervertebral spaces in order to select an appropriate X/DLIF approach to avoid nerve and large vessels injury. Magnetic resonance imaging scanning on lumbar intervertebral spaces was performed in 48 patients (24 males, 24 females, 54.2 years on average). According to Moro’s method, lumbar intervertebral space was divided into six zones A, I, II, III, IV and P. Thickness of psoas major was measured and distribution of abdominal large vessels was surveyed at each zone. The results show vena cava migrate from the right of zone A to the right of zone I at L1/2–L4/5; abdominal aorta was located mostly to the left of zone A at L1/2–L3/4 and divided into bilateral iliac arteries at L4/5; Psoas major was tenuous and dorsal at L1/2 and L2/3, large and ventral at L3/4 and L4/5. Combined with the distribution of nerve roots reported by Moro, X/DLIF approach is safe via zones II–III at L1/2 and L2/3, and via zone II at L3/4. At L4/5, it is safe via zones I–II in left and via zone II in right side, respectively.


X/DLIF Psoas Major Abdominal large vessels MRI Study 


Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Wan-Kun Hu
    • 1
  • Shi-Sheng He
    • 3
    Email author
  • Shao-Cheng Zhang
    • 1
  • Yan-Bin Liu
    • 1
  • Ming Li
    • 1
  • Tie-Sheng Hou
    • 1
  • Xiao-Lu Ma
    • 2
  • Jian Wang
    • 2
  1. 1.Department of OrthopedicsChanghai HospitalShanghaiChina
  2. 2.Department of RadiologyChanghai HospitalShanghaiChina
  3. 3.Department of OrthopedicsShanghai 10th People’s Hospital, Tongji University School of MedicineShanghaiChina

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