Preventing L5-S1 discitis associated with sacrocolpopexy

Area of Science:

• Anatomy
• Surgical Procedures
• Gynecologic Surgery

Background:

• Sacrocolpopexy requires precise anatomical knowledge of the lumbosacral region.
• The L5-S1 disc space and sacral promontory are critical landmarks for successful surgical outcomes.
• Variations in lumbosacral anatomy can pose challenges during sacrocolpopexy.

Purpose of the Study:

• To characterize the anatomy of the fifth lumbar to first sacral (L5-S1) disc space.
• To identify reliable anatomic landmarks for predicting the locations of the L5-S1 disc and sacral promontory.
• To aid in the intraoperative localization of structures during sacrocolpopexy.

Main Methods:

• Examination of lumbosacral anatomy in 25 female cadavers.
• Analysis of 100 computed tomography (CT) studies.
• Measurements referenced from the midpoint of the sacral promontory; statistical analysis using Pearson chi-square, unpaired Student's t-test, and analysis of covariance.

Main Results:

• The average L5-S1 disc height was 1.8 cm in cadavers and 1.4 cm on CT.
• The average angle of descent between the anterior surfaces of L5 and S1 was approximately 60.5 degrees in cadavers and 65.3 degrees on CT.
• The first sacral nerve was located approximately 3 cm from the upper sacrum and 1.5 cm from the midline.

Conclusions:

• The L5-S1 disc is the most prominent presacral structure in the supine position, extending beyond the sacral promontory.
• Awareness of the average 60-degree drop between L5 and S1 aids intraoperative localization and avoidance of the L5-S1 disc during sacrocolpopexy.
• Anatomical landmarks identified can improve surgical precision and safety in sacrocolpopexy procedures.