Anatomical Evaluation of Lumbar Arteries for Lateral Lumbar Interbody Fusion with Magnetic Resonance Imaging

Abstract

Introduction: Lateral lumbar interbody fusion (LLIF) is becoming a more common surgical treatment option for adult degenerative lumbar conditions. LLIF is a mini-open access technique with wound retractors, and postoperative hematoma due to segmental vessels injury is reported. Thus, it is considered that there is a need to conduct detailed preoperative examinations to identify where the lumbar vessels are. As far as we know, there are only a few studies investigating the location of the lumbar arteries. This study evaluates the anatomical position of lumbar arteries using magnetic resonance imaging (MRI). Methods: We studied 101 MRIs of patients with lumbar disease. The length from the upper and lower end plates of the vertebra to the lumbar arteries was measured. The measurement was conducted with coronal MRI images of every quarter slice of L1 to L4 vertebrae. We also investigated sagittal MRI images to determine whether the lumbar vessels are located on intervertebral disc in each level from L1/2 to L5/S1. Results: The lumbar vessels are not always located at the center of the vertebrae. Some lumbar vessels are located within 8 mm from the end plates. Especially in L4, the lumbar vessels tended to go down from the anterior cranial side to the posterior caudal side (P < 0.01). 8, 24, and 54 lumbar vessels are located at the anterior quarter, the center, and the posterior quarter slice of the vertebrae, respectively, in L4. There were seven lumbar vessels in total located on the vertebral disc level. Conclusions: It is necessary to investigate where the lumbar arteries are located to prevent its injury in LLIF, because the lumbar artery is not always located at the center of a vertebra. MRIs may provide a valuable information to avoid vascular injury during LLIF.

Vascular Injury in Elective Anterior Surgery of the Lumbar Spine: A Narrative Review

“…Also, it is quite clear in recent studies, that the presence of vascular injuries and postoperative venous thrombosis leads to increased transfusion rates, morbidity, and in-hospital mortality, as highlighted by Goot et al, where the most cases of injury signed in the left common iliac vein (LCIV) [ 19 - 20 ]. On the other hand, Chiriano et al reported that by anterior retroperitoneal access to the lumbar spine (ARES), the frequency of vascular injury in cases involving the disc of L4-L5 was higher in comparison with the other levels while CIV laceration was associated with higher rates of postoperative deep vein thrombosis [ 21 ].…”

Anatomical Characteristics and Variations of Thoracic Segmental Arteries with 3-dimensional CT Analysis

“…There are some reports on the anatomical evaluation of arteries in the cervical and lumbar spine. [11][12][13][14] Meanwhile, a few cadaver studies on the thoracic spine have been reported, with no previous detailed analysis using 3D-CT in the upper to middle thoracic spine. This study aimed to investigate the anatomical characteristics and variations of the thoracic segmental arteries.…”

“…Computed tomography angiography (CTA) and 3D reconstruction images have helped develop human vascular anatomy, provided a view similar to surgical anatomy, and aided in diagnosis and preoperative planning. There are some reports on the anatomical evaluation of arteries in the cervical and lumbar spine 11–14. Meanwhile, a few cadaver studies on the thoracic spine have been reported, with no previous detailed analysis using 3D-CT in the upper to middle thoracic spine.…”

Avoiding Lumbar Segmental Arteries Injury in Oblique Lateral Interbody Fusion Procedure

“…16 Recently, MRI of patients with lumbar disease has shown that lumbar vessels are not necessarily located at the center of the vertebral body since many individual differences occur, especially in L4, where the lumbar vessels verge down from the anterior cranial side to the posterior caudal side. 17 However, results coming from MRI can suffer from a low accurate…”