An anatomical study on lumbar arteries related to the extrapedicular approach applied during lumbar PVP (PKP)

Abstract

To observe the regional anatomy of the lumbar artery (LA) associated with the extrapedicular approach applied during percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP), we collected 78 samples of abdominal computed tomography angiography imaging data. We measured the nearest distance from the center of the vertebral body puncture point to the LA (distance VBPP-LA, D VBPP-LA ). According to the D VBPP-LA , four zones, Zone I, Zone II, Zone III and Zone IV, were identified. LAs that passed through these zones were called Type I, Type II, Type III and Type IV LAs, respectively. A portion of the lumbar vertebrae had an intersegmental branch that originated from the upper segmental LA and extended longitudinally across the lateral wall of the pedicle; it was called Type V LA. Compared with the D VBPP-LA in L1, L2, L3 and L4, the overall difference and between-group differences were significant ( P < 0.05). In L1, L2, L3, L4 and L5, there were 8, 4, 4, 0 and 1 Type I LAs, respectively. There were no Type V LAs in L1 and L2, but there were 2, 16 and 26 Type V LAs in L3, L4 and L5, respectively. In L1-L5, the numbers of Type I LA plus Type V LA were 8, 4, 6, 16 and 27, and the presence ratios were 5.1%, 2.6%, 5.6%, 10.3% and 17.3%, respectively. In L4 and L5, the male presence ratios of Type I LA plus Type V LA were 7.1% and 10.7%, respectively, and the female presence ratios were 13.9% and 25.0%, respectively. Thus, extrapedicular PVP (PKP) in lumbar vertebrae had a risk of LA injury and was not suggested for use in L4 and L5, especially in female patients.

Unilateral percutaneous vertebroplasty for osteoporotic lumbar compression fractures: a comparative study between transverse process root-pedicle approach and conventional transpedicular approach

“…Some studies [ 7 , 8 ] on anatomy and imaging have shown that the extrapedicular and transverse process root-pedicle approach (TPRPA) can be used for PVP, but individual and level selection is required. TPRPA penetrates the pedicle through the root of the transverse process and lateral part of the pedicle, which allows for a greater abduction angle and it is relatively safer [ 8 ].…”

Unilateral Transforaminal Approach (UTFA) in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Novel Puncture Technique

“…The optimal target location for unilateral PVP is one-third anterior and midline of the VB so that bone cement can diffuse to the unpunctured side, which balances the stress on the VB [19,27]. Therefore, the unipedicular approach requires a more aggressive medial-inclination angle, which can lead to complications of facet joint damage, pedicle disruption and spinal-canal intrusion [13,28]; meanwhile, the extrapedicular approach carries the risk of lumbar-artery injury [14][15][16]. In this study, we used the unilateral transforaminal approach to PVP for the treatment of OVCFs.…”

“…The operation is performed under local anesthesia so that the patient can be asked about sensations of radiating pain, to avoid the risk of nerve root damage. In the process of puncturing the vertebral surface, the bone needle is placed above the superior notch of the pedicle to avoid injuring segmental vessels [14][15][16], and not beyond the medial margin of the ipsilateral pedicle, to avoid damaging the spinal cord and dura. In our study, we saw no complications of spinal-cord or nerve root injuries, hematomata or bone cement embolism, which further a rmed the safety of this method.…”

“…At this writing, there is still no consensus on the optimal approach, but the unilateral approaches, which have the advantages of shorter operation time, lower radiation dose and less cement leakage, have gradually come to be accepted [11,12]. However, the unilateral transpedicular approach has the complications of facet joint damage, pedicle disruption and spinal-canal intrusion [13], and the unilateral extrapedicular approach can injure the lumbar artery [14][15][16]. To avoid the above-mentioned disadvantages, we used the unilateral transforaminal approach (UTFA) to PVP for the treatment of OVCFs.…”

Percutaneous Para-Pedicular Vertebroplasty for an Uppermost Instrumented Vertebral Fracture: A Case Report

“…7,8) In this study, a 71 year-old male patient who had a history use in L4 and L5 vertebra, especially in female patients. 12) As forementioned, however, the parapedicular approach can provide a favorable access to the center of the anterior column of vertebra in instrumented vertebra, which has limited access to the transpedicular approach by previously inserted pedicle screws and vertical rod, without significant surgical morbidity. 4) It is known that PMMA cement augmentation though this approach reduces intractable back pain by stabilizing the anterior column, restoring the vertebral height, and reinforcing the pedicle screw construct.…”