Lumbar artery branches coursing vertically over the intervertebral discs of the lower lumbar spine: an anatomic study

Nojiri, Hidetoshi; Miyagawa, Kei; Banno, Sammy; Sakamoto, Ikko; Koike, Masato; Sawa, Mamiko; Iwase, Yoshiyuki; Kudo, Hiroyuki; Sakai, Tatsuo

doi:10.1007/s00586-016-4729-4

Cited by 17 publications

(10 citation statements)

References 17 publications

(20 reference statements)

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“…to course over the L3-4 disks in the eight of nine (88.9%) subjects without L4 SegAL, and branches of the L4 SegAL were found to run across the L4-5 disks in 25 of 97 (25.8%) volunteers without the L5 SegAL (Figure 3). The presence of the branches within the IVD space was more frequent at the L4-5 disks than at the L3-4 disks, which is consistent with a previous study of Nojiri et al (19). As shown in Figure 3, the current study clearly demonstrated the existence of the branches within the posterolateral L3-4 IVD and L4-5 IVD spaces and also discovered the branches of the L3 SegAL coursing over the disks in subjects without the L4 SegAL.…”

Section: Discussionsupporting

confidence: 92%

The trajectory characteristics and clinical significance of the left-sided lumbar segmental artery: a prospective cross-sectional radio-anatomical study

Huang¹,

Zhou²,

Xie³

et al. 2022

Quant Imaging Med Surg

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Background: Vascular injury to the lumbar segmental arteries is a devastating complication in minimally invasive lumbar interbody fusion. Previous studies on the anatomy of the lumbar segmental arteries are limited. This prospective cross-sectional study aims to quantitatively describe the brief trajectory of the lumbar segmental arteries on the left side (SegAL) and to discuss its clinical significance.Methods: One hundred and two asymptomatic volunteers were prospectively enrolled and underwent computed tomography angiography (CTA). Anatomical parameters including the existence rate, relative positions and directions of SegAL were measured. Mann-Whitney U tests were performed, and statistical significance was set at P<0.05.Results: A total of 404 lumbar SegAL were identified. The SegAL of L1, L2 and L3 were identified in all subjects while the L4 SegAL were absent in 9 of 102 (8.8%) and the L5 SegAL were absent in 97 of 102 (95.1%) volunteers. In 25 of 97 (25.8%) volunteers without the L5 SegAL, the branches of the L4 SegAL ran along the disks. Meanwhile, the branches of L3 intersecting over the intervertebral discs (IVD) were found in 8 of 9 (88.9%) subjects without the L4 SegAL and in 4 of 93 (4.3%) subjects with L4 SegAL. The branch angles between the L1, L2 SegAL and the aorta were significantly acute (P<0.05). The L3 SegAL ran approximately vertically with the aorta while the branch angles of the L4 SegAL were significantly blunt (P<0.05). according to the distances measured, on the anterior vertebral walls, the SegAL of L1 and L2 were significantly closer to the inferior vertebral walls than the SegAL of L3 and L4, while on the posterior vertebral walls, the L3 and L4 SegAL were significantly closer to the inferior walls.Conclusions: Arterial branches may course over the L3-4 and L4-5 IVD spaces and the branches over the L3-4 disks are more likely to be present when L4 segmental arteries are absent, thus posing potential risks of arterial complications. Because of the SegAL adjacent to the disks, the risk of arterial injury may be higher anteriorly at L1 and L2 and higher posteriorly at L3 and L4.

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Section: Discussionsupporting

confidence: 92%

The trajectory characteristics and clinical significance of the left-sided lumbar segmental artery: a prospective cross-sectional radio-anatomical study

Huang¹,

Zhou²,

Xie³

et al. 2022

Quant Imaging Med Surg

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“…Previous studies on the anatomy of the lumbar artery have focused on the soft-tissue distribution of arteries around the spinal nerve with the aim of avoiding neurological symptoms during endoscopic surgery [14]. It is generally considered that surgery adjacent to the lumbar intervertebral disc will avoid injury to the lumbar artery in oblique lumbar interbody fusion (OLIF) or extreme lateral interbody fusion (XLIF) [15,16]. To our knowledge, there are no studies on the safe area of extrapedicular PVP puncture, especially the distribution of blood vessels around the pedicle.…”

Section: Discussionmentioning

confidence: 99%

An Anatomical Feasibility Study Using CTA Reconstruction for Modified Percutaneous Lumbar Vertebroplasty

Guo

Fan

et al. 2022

Preprint

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Study Design. Observational anatomical imaging study Objective. To investigate the anatomical feasibility of percutaneous vertebroplasty for lumbar osteoporotic vertebral compression fractures via a unilateral Extrapedicular approach. Summary of Background Data. Lumbar vertebroplasty via several different types of extrapedicular approach has been reported with acceptable clinical results yet the anatomical basis for its safety is not fully explored. Injury to the lumbar arteries (LAs) is one of the most important potential complications. However, anatomical research on the course and variability of this structure is lacking.Methods. A total of 300 LAs of 30 patients with non-spinal disorders were retrospectively analyzed by computed tomographic angiography (CTA). The lateral aspect of the vertebral body was divided into 9 zones of approximately equal area. The anatomy and orientation of LAs were analyzed in detail.Results. LAs were most commonly found in the middle third of the body (zones 4, 5, and 6); the upper 1/3 of the vertebral body had LAs distributed only anteriorly and laterally (zones 1 and 2). No arteries were observed in the postero-superior segment (zone 3 ). From L1 to L3 an arched pattern predominated. At L4 an inferior oblique pattern (antero-superior to postero-inferior) predominated. Limited CTA visualization at L4 and particularly L5 as well as greater anatomical variation means that there is more uncertainty at these levels. Conclusion. From L1 to L3, the posterior superior segment (zone 1) of the vertebral body appears to be a safe area with low risk of arterial injury. This has relevance for design of a safe lumbar vertebral extrapedicular approach.

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“…The extrapedicular puncture path is adjacent to the LA; thus, understanding the trend and distribution of the LA in the posterolateral vertebral body and the lateral side of the pedicle is very important. At present, anatomical studies related to LAs mainly focus on extreme lateral lumbar interbody fusion, [10] lumbar discectomy, [11] and flap transplantation with LA perforators. [12] However, within the scope of the literature, there is no systematic study on the anatomy of the LA associated with the extrapedicular approach applied during lumbar PVP (PKP).…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Cheng²,

Wang

et al. 2019

PLoS ONE

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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.

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Lumbar artery branches coursing vertically over the intervertebral discs of the lower lumbar spine: an anatomic study

Abstract: Lumbar artery branches coursed vertically over the middle third and the posterior third of the lateral sides of the intervertebral discs in approximately 3 and 30 % of subjects, respectively.

Cited by 17 publications

References 17 publications

The trajectory characteristics and clinical significance of the left-sided lumbar segmental artery: a prospective cross-sectional radio-anatomical study

The trajectory characteristics and clinical significance of the left-sided lumbar segmental artery: a prospective cross-sectional radio-anatomical study

An Anatomical Feasibility Study Using CTA Reconstruction for Modified Percutaneous Lumbar Vertebroplasty

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

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