Huang Weibo, Zhou Ping, Xie Lin, Huang Zhongxiong, Zheng Chaojun, Ma Xiaosheng, Wang Hongli, Jiang Jianyuan
Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
PET-CT Center, Chenzhou First People's Hospital, Xiangnan University, Chenzhou, China.
Quant Imaging Med Surg. 2022 Mar;12(3):1977-1987. doi: 10.21037/qims-21-867.
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.
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.
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.
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.
腰段节段动脉的血管损伤是微创腰椎椎间融合术中一种严重的并发症。以往关于腰段节段动脉解剖的研究有限。本前瞻性横断面研究旨在定量描述左侧腰段节段动脉（SegAL）的简短走行，并探讨其临床意义。
前瞻性纳入102名无症状志愿者并进行计算机断层扫描血管造影（CTA）。测量包括SegAL的存在率、相对位置和走行方向等解剖学参数。进行曼-惠特尼U检验，设定P<0.05为具有统计学意义。
共识别出404条腰段SegAL。所有受试者均识别出L1、L2和L3的SegAL，而102名受试者中有9名（8.8%）未识别出L4的SegAL，102名受试者中有97名（95.1%）未识别出L5的SegAL。在97名无L5 SegAL的志愿者中，有25名（25.8%）L4 SegAL的分支沿椎间盘走行。同时，在9名无L4 SegAL的受试者中有8名（88.9%）以及93名有L4 SegAL的受试者中有4名（4.3%）发现L3的分支在椎间盘（IVD）上方交叉。L1、L2 SegAL与主动脉之间的分支角度明显更锐（P<0.05）。L3 SegAL与主动脉大致垂直走行，而L4 SegAL的分支角度明显更钝（P<0.05）。根据测量的距离，在椎体前壁，L1和L2的SegAL比L3和L4的SegAL更靠近椎体下壁，而在椎体后壁，L3和L4的SegAL更靠近下壁。
动脉分支可能在L3 - 4和L4 - 5椎间盘间隙上方走行，当L4节段动脉缺如时，L3 - 4椎间盘上方的分支更可能存在，从而带来动脉并发症的潜在风险。由于SegAL邻近椎间盘，L1和L2水平前方以及L3和L4水平后方的动脉损伤风险可能更高。
