The anatomical relationship of the aortic bifurcation to the lumbar vertebrae: a MRI study

Abstract

The objective of this study was to determine the level of the aortic bifurcation in relation to the lumbar spine by MRI and the effect of lumbosacral anomalies on the aortic bifurcation. A prospective study of 441 patients was performed. Sagittal MR images of the entire spine were obtained along with the standard protocol for imaging of the lumbar spine. The vertebrae were counted caudally from C2 instead of cranially from the presumed L5 vertebra. The aortic bifurcation in relation to the lumbar vertebrae was determined. The aorta bifurcated at the L4 vertebral body in 67% of cases. In patients with sacralization of L5 the aortic bifurcation was at the L3 vertebral body in 59%. In those patients with lumbarization of S1 the aorta bifurcated at the level of the L4 vertebral body in 40% and at the L4/5 disc space in 33%. There was no demographic variation of the aortic bifurcation in relation to age or sex. The aorta bifurcated at L4 in two-thirds of cases and was variably located in the remaining third. The stability of this as a landmark is disturbed by the significant high incidence of lumbosacral transitional segments.

Are Spinal or Paraspinal Anatomic Markers Helpful for Vertebral Numbering and Diagnosing Lumbosacral Transitional Vertebrae?

“…It was also reported by other studies (4, 6, 22) and they suggested that if these structures were located outside of the frequent sites, the presence of LSTV should be suspected. However, when using the lumbar MRI alone, we defined vertebral levels incorrectly in 14.1% of the patients.…”

“…In MRI studies by Lee et al (6) and Chithriki et al (22), AB was found at L4 body in 83% and 67% of the cases, respectively. Another study by Lee et al (4) revealed that in the normal group, the AB was most prevalent between the upper half of L4 body and L4-5 disc in 94.8% of the cases.…”

Anatomy of the superior hypogastric plexus and its application in nerve-sparing paraaortic lymphadenectomy

“…Anatomical landmarks such as the aortic bifurcation, the transitional points of the abdominal aorta to the bilateral common iliac arteries, the cross point of the right ureter and the pelvic brim, and the cross point of the sigmoid mesentery and the pelvic brim were selected for morphometric analysis. The aortic bifurcation and the right ureter were easily identifiable by inspection or palpation under the retroperitoneum even during surgery and have been used successfully as anatomical landmarks in previous radiologic [5,16] and dissection studies [18,21]. The root of the sigmoid mesentery was selected because the left ureter was covered by the root of the sigmoid mesentery [6].…”

Diagnosis of High Bifurcation of the Abdominal Aorta with Associated Vascular Variations: Case Report with Multidedector Computed Tomography

“…They found that BAA was at the upper half of the L4 vertebral body in 45% of patients, at the lower half of L4 in 38% of patients, at the L3–L4 intervertebral disk space in 10% of patients, at the L4–L5 intervertebral disk space of the level in 4% of patients, and at the lower half of L3 in 2% of patients. Chithriki et al [ 2 ] assessed the level of BAA in relation to the lumbar spine using MRI. They noted that BAA was found at the L4 vertebral body in 67% of patients, at the L3/L4 vertebral bodies in 13% of patients, and at the L3 vertebral body in 9% of patients.…”

“…Vascular variations of the bifurcation of the abdominal aorta (BAA) are rare, and they are usually discovered incidentally by manifestations of chronic lower limb ischemia. The most common site of BAA was at the L4 vertebra (67–83%) [ 1 , 2 ]. The BAA can be at an elevated level of the L3 vertebral body in rare cases [ 1 – 3 ].…”