The Surgical Anatomy of the Lumbosacroiliac Triangle

A Cadaveric Study

Carmine Zoccali, Jesse Skoch, Apar S. Patel, Christina M. Walter, Mauricio J. Avila, Nikolay L. Martirosyan, Silvio Demitri, Ali A. Baaj

Research output: Contribution to journalArticle

Abstract

Objective The anatomic area delineated medially by the lateral part of the L4-L5 vertebral bodies, distally by the anterior-superior surface of the sacral wing, and laterally by an imaginary line joining the base of the L4 transverse process to the proximal part of the sacroiliac joint, is of particular interest to spine surgeons. We are referring to this area as the lumbo-sacro-iliac triangle (LSIT). Knowledge of LSIT anatomy is necessary during approaches for L5 vertebral and sacral fractures, sacral and iliac tumors, and extraforaminal decompression of the L5 nerve roots. Methods We performed an anatomic dissection of the LSIT in 3 embalmed cadavers (6 triangles), using an anterior and posterior approach. Results We identified 3 key tissue planes: the neurological plexus plane, constituted by L4 and L5 nerve roots; an intermediate level constituted by the ileosacral tunnel; and posteriorly, by the lumbosacral ligament, and the posterior muscular plane. Conclusions Improving anatomic knowledge of the LSIT may help surgeons decrease the risk of possible complications. When LSIT pathology is present, a lateral approach corresponding to the tip of the L4 transverse process, medially, is suggested to decrease the risk of vessel and nerve root damage.

Original languageEnglish
Pages (from-to)36-40
Number of pages5
JournalWorld Neurosurgery
Volume88
DOIs
Publication statusPublished - 2016

Fingerprint

Anatomy
Sacroiliac Joint
Decompression
Cadaver
Ligaments
Dissection
Spine
Pathology
Neoplasms
Surgeons

Keywords

  • Extraforaminal compression
  • Ileo-lumbar ligament
  • Ileo-sacral ligament
  • Ileo-sacral tunnel
  • Key words Ascending lumbar vein
  • Vertebral body osteophyte

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Zoccali, C., Skoch, J., Patel, A. S., Walter, C. M., Avila, M. J., Martirosyan, N. L., ... Baaj, A. A. (2016). The Surgical Anatomy of the Lumbosacroiliac Triangle: A Cadaveric Study. World Neurosurgery, 88, 36-40. https://doi.org/10.1016/j.wneu.2015.11.083

The Surgical Anatomy of the Lumbosacroiliac Triangle : A Cadaveric Study. / Zoccali, Carmine; Skoch, Jesse; Patel, Apar S.; Walter, Christina M.; Avila, Mauricio J.; Martirosyan, Nikolay L.; Demitri, Silvio; Baaj, Ali A.

In: World Neurosurgery, Vol. 88, 2016, p. 36-40.

Research output: Contribution to journalArticle

Zoccali, C, Skoch, J, Patel, AS, Walter, CM, Avila, MJ, Martirosyan, NL, Demitri, S & Baaj, AA 2016, 'The Surgical Anatomy of the Lumbosacroiliac Triangle: A Cadaveric Study', World Neurosurgery, vol. 88, pp. 36-40. https://doi.org/10.1016/j.wneu.2015.11.083
Zoccali, Carmine ; Skoch, Jesse ; Patel, Apar S. ; Walter, Christina M. ; Avila, Mauricio J. ; Martirosyan, Nikolay L. ; Demitri, Silvio ; Baaj, Ali A. / The Surgical Anatomy of the Lumbosacroiliac Triangle : A Cadaveric Study. In: World Neurosurgery. 2016 ; Vol. 88. pp. 36-40.
@article{dabd1e9d853143a2ab47b19a761aa2ae,
title = "The Surgical Anatomy of the Lumbosacroiliac Triangle: A Cadaveric Study",
abstract = "Objective The anatomic area delineated medially by the lateral part of the L4-L5 vertebral bodies, distally by the anterior-superior surface of the sacral wing, and laterally by an imaginary line joining the base of the L4 transverse process to the proximal part of the sacroiliac joint, is of particular interest to spine surgeons. We are referring to this area as the lumbo-sacro-iliac triangle (LSIT). Knowledge of LSIT anatomy is necessary during approaches for L5 vertebral and sacral fractures, sacral and iliac tumors, and extraforaminal decompression of the L5 nerve roots. Methods We performed an anatomic dissection of the LSIT in 3 embalmed cadavers (6 triangles), using an anterior and posterior approach. Results We identified 3 key tissue planes: the neurological plexus plane, constituted by L4 and L5 nerve roots; an intermediate level constituted by the ileosacral tunnel; and posteriorly, by the lumbosacral ligament, and the posterior muscular plane. Conclusions Improving anatomic knowledge of the LSIT may help surgeons decrease the risk of possible complications. When LSIT pathology is present, a lateral approach corresponding to the tip of the L4 transverse process, medially, is suggested to decrease the risk of vessel and nerve root damage.",
keywords = "Extraforaminal compression, Ileo-lumbar ligament, Ileo-sacral ligament, Ileo-sacral tunnel, Key words Ascending lumbar vein, Vertebral body osteophyte",
author = "Carmine Zoccali and Jesse Skoch and Patel, {Apar S.} and Walter, {Christina M.} and Avila, {Mauricio J.} and Martirosyan, {Nikolay L.} and Silvio Demitri and Baaj, {Ali A.}",
note = "Zoccali C. doppia affiliazione",
year = "2016",
doi = "10.1016/j.wneu.2015.11.083",
language = "English",
volume = "88",
pages = "36--40",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - The Surgical Anatomy of the Lumbosacroiliac Triangle

T2 - A Cadaveric Study

AU - Zoccali, Carmine

AU - Skoch, Jesse

AU - Patel, Apar S.

AU - Walter, Christina M.

AU - Avila, Mauricio J.

AU - Martirosyan, Nikolay L.

AU - Demitri, Silvio

AU - Baaj, Ali A.

N1 - Zoccali C. doppia affiliazione

PY - 2016

Y1 - 2016

N2 - Objective The anatomic area delineated medially by the lateral part of the L4-L5 vertebral bodies, distally by the anterior-superior surface of the sacral wing, and laterally by an imaginary line joining the base of the L4 transverse process to the proximal part of the sacroiliac joint, is of particular interest to spine surgeons. We are referring to this area as the lumbo-sacro-iliac triangle (LSIT). Knowledge of LSIT anatomy is necessary during approaches for L5 vertebral and sacral fractures, sacral and iliac tumors, and extraforaminal decompression of the L5 nerve roots. Methods We performed an anatomic dissection of the LSIT in 3 embalmed cadavers (6 triangles), using an anterior and posterior approach. Results We identified 3 key tissue planes: the neurological plexus plane, constituted by L4 and L5 nerve roots; an intermediate level constituted by the ileosacral tunnel; and posteriorly, by the lumbosacral ligament, and the posterior muscular plane. Conclusions Improving anatomic knowledge of the LSIT may help surgeons decrease the risk of possible complications. When LSIT pathology is present, a lateral approach corresponding to the tip of the L4 transverse process, medially, is suggested to decrease the risk of vessel and nerve root damage.

AB - Objective The anatomic area delineated medially by the lateral part of the L4-L5 vertebral bodies, distally by the anterior-superior surface of the sacral wing, and laterally by an imaginary line joining the base of the L4 transverse process to the proximal part of the sacroiliac joint, is of particular interest to spine surgeons. We are referring to this area as the lumbo-sacro-iliac triangle (LSIT). Knowledge of LSIT anatomy is necessary during approaches for L5 vertebral and sacral fractures, sacral and iliac tumors, and extraforaminal decompression of the L5 nerve roots. Methods We performed an anatomic dissection of the LSIT in 3 embalmed cadavers (6 triangles), using an anterior and posterior approach. Results We identified 3 key tissue planes: the neurological plexus plane, constituted by L4 and L5 nerve roots; an intermediate level constituted by the ileosacral tunnel; and posteriorly, by the lumbosacral ligament, and the posterior muscular plane. Conclusions Improving anatomic knowledge of the LSIT may help surgeons decrease the risk of possible complications. When LSIT pathology is present, a lateral approach corresponding to the tip of the L4 transverse process, medially, is suggested to decrease the risk of vessel and nerve root damage.

KW - Extraforaminal compression

KW - Ileo-lumbar ligament

KW - Ileo-sacral ligament

KW - Ileo-sacral tunnel

KW - Key words Ascending lumbar vein

KW - Vertebral body osteophyte

UR - http://www.scopus.com/inward/record.url?scp=84959464238&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959464238&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2015.11.083

DO - 10.1016/j.wneu.2015.11.083

M3 - Article

VL - 88

SP - 36

EP - 40

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -