Is the area posterior to the psoas (major muscle in the lower back) muscle located away from the lumbar lymphatic chain?

From the Guidelines

Yes, the area posterior to the psoas muscle is generally located away from the lumbar lymphatic chain. The posterior aspect of the psoas muscle is adjacent to the transverse processes of the lumbar vertebrae and the quadratus lumborum muscle, which suggests that the major lymphatic vessels and nodes are primarily located anterior and medial to the psoas muscle, particularly along the aorta and inferior vena cava (para-aortic and paracaval lymph nodes) 1. Key points to consider include:

• The psoas muscle serves as a natural anatomical boundary, separating the posterior region from the main lymphatic chain.
• Surgical approaches, such as those described for retroperitoneal sarcomas, often involve resection of the tumor and adjacent viscera, but the posterior surface of the psoas muscle is relatively free of lymphatic structures 1.
• The retroperitoneal space behind the psoas muscle provides a pathway that can be utilized in surgical approaches to minimize the risk of lymphatic injury.
• The anatomical arrangement of the psoas muscle and surrounding structures is crucial in understanding the relationship between the posterior psoas surface and the lumbar lymphatic chain, as discussed in the context of retroperitoneal tumors and their management 1.

From the Research

Anatomical Relationship Between Psoas Muscle and Lumbar Lymphatic Chain

• The area posterior to the psoas muscle is relevant to surgical approaches for lumbar spine access, such as the lateral transpsoas interbody fusion (LTIF) 2 and the mini-open lateral retroperitoneal lumbar spine approach 3.
• Studies have focused on the relationship between the psoas muscle and the lumbar plexus, as well as the position of the lumbar sympathetic chain (LSC) in relation to the psoas muscle and the aorta 4.
• The lumbar lymphatic chain is not directly mentioned in the provided studies, but the lumbar sympathetic chain is discussed in relation to the surgical corridor for the retroperitoneal oblique approach to the lumbar spine 4.

Surgical Approaches and Anatomical Considerations

• The lateral transpsoas interbody fusion (LTIF) approach requires a thorough understanding of the neurovascular structures, including the psoas muscle, lumbar plexus, and vascular structures 2.
• The mini-open lateral retroperitoneal lumbar spine approach uses a psoas muscle retraction technique to avoid injury to the lumbar plexus 3.
• The dynamic retraction of the psoas muscle can provide excellent visualization of the spine, particularly the neural elements 5.
• The safe working zone for the minimally invasive lateral retroperitoneal transpsoas approach has been defined as the area anterior to the nerve root and posterior to the retroperitoneal vessels 6.

Position of the Lumbar Sympathetic Chain

• The lumbar sympathetic chain (LSC) runs in the corridor between the psoas muscle and the aorta, making it a structure at risk of injury during the retroperitoneal oblique approach to the lumbar spine 4.
• The distance between the LSC and the psoas muscle increases from L2-3 to L4-5, while the distance between the LSC and the aorta decreases 4.
• These findings suggest that the LSC moves away from the psoas muscle and becomes closer to the aorta at the L4-5 disc level 4.