European Spine Journal

, Volume 28, Issue 4, pp 829–834 | Cite as

Relation of lumbar sympathetic chain to the open corridor of retroperitoneal oblique approach to lumbar spine: an MRI study

  • A. Mahatthanatrakul
  • T. Itthipanichpong
  • C. Ratanakornphan
  • N. Numkarunarunrote
  • W. Singhatanadgige
  • W. Yingsakmongkol
  • W. LimthongkulEmail author
Original Article



Retroperitoneal oblique approach to lumbar spine used surgical corridor between psoas muscle and aorta for exposure to anterior part of lumbar spine. Lumbar sympathetic chain (LSC) runs in the corridor to make it a structure at risk of injury.

Research question

Does LSC relationship with surgical corridor for minimally invasive retroperitoneal anterolateral oblique approach change in different intervertebral disc level?


Left LSC was identified in axial magnetic resonance imaging images at L2–3, L3–4 and L4–5 intervertebral disc levels of 144 patients. Distances between LSC and left psoas muscle and aorta were recorded.


Mean age of the patients was 62.3 years. LSC was identifiable in 90.9% of levels. Distance between LSC and psoas muscle at L2–3, L3–4 and L4–5 was 4.0 mm, 4.7 mm and 5.2 mm. Statistical difference was found between L2–3 and L4–5 level (p = 0.006). Distance between LSC and aorta at each level was 12.4 mm, 12.3 mm and 10.6 mm without statistical difference. In non-scoliosis group distance between LSC and psoas muscle at each level was 3.1 mm, 3.3 mm and 4.0 mm. Statistical difference was found between L2–3 and L4–5 level (p = 0.012) and between L3–4 and L4–5 level (p = 0.041). Distance between LSC and aorta at each level was 11.9 mm, 11.4 mm and 10.2 mm. Statistical difference was found between L2–3 and L4–5 disc level (p = 0.039).


LSC moves away from psoas muscle and becomes closer to aorta in L4–5 disc level.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Oblique lumbar interbody fusion Lumbar sympathetic chain Magnetic Resonance Imaging Oblique corridor Minimally invasive surgical approach 


Compliance with ethical standards

Conflict of interest

W. Limthongkul is a consultant for Medtronic. There is no funding or grants related to this research.

Supplementary material

586_2018_5779_MOESM1_ESM.pptx (164 kb)
Supplementary material 1 (PPTX 164 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • A. Mahatthanatrakul
    • 1
  • T. Itthipanichpong
    • 2
  • C. Ratanakornphan
    • 3
  • N. Numkarunarunrote
    • 3
  • W. Singhatanadgige
    • 2
  • W. Yingsakmongkol
    • 2
  • W. Limthongkul
    • 2
    Email author
  1. 1.Department of Orthopaedics, Faculty of MedicineNaresuan University HospitalPhitsanulokThailand
  2. 2.Department of Orthopaedics, Faculty of MedicineChulalongkorn UniversityBangkokThailand
  3. 3.Department of Radiology, Faculty of MedicineChulalongkorn UniversityBangkokThailand

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