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An anatomical study of the origins courses and distributions of the transverse branches of lumbar arteries at the L1–L4 levels

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Abstract

Summary of background

Pseudoaneurysms of the lumbar arteries following transforaminal lumbar interbody fusion (TLIF) are rare postoperative complications that usually occur around the transverse process. However, there are few detailed descriptions of the transverse branch and other branches of the dorsal branches at the L1–L4 disks.

Study design

Ten adult embalmed cadavers were anatomically studied.

Objectives

The purposes of the study were to describe the vascular distribution of the dorsal branches, especially the transverse branches, at the L1–L4 levels and provide information useful for TLIF.

Methods

Ten embalmed cadavers studied after their arterial systems were injected with red latex. The quantity, origin, pathway, distribution range and diameter of the branches were recorded and photographed.

Results

The transverse branch appeared in all 80 intervertebral foramina. The transverse branch was divided into 2 types: In type 1, the arteries divided into superior branches and inferior branches; the arteries in type 2 divided into 3 branches (superior, intermedius and inferior branches).

Conclusions

The transverse branches of the dorsal arteries are common structures from L1 to L4, and 2 types of transverse branches were found. A thorough understanding of the dorsal branches, especially the transverse branches of the lumbar artery, may be very important for reducing both intraoperative bleeding during the surgery and the occurrence of pseudoaneurysms after transforaminal lumbar interbody fusion.

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References

  1. Rihn JA, Patel R, Makda J et al (2009) Complications associated with single-level transforaminal lumbar interbody fusion. Spine J 9(8):623–629. https://doi.org/10.1016/j.spinee.2009.04.004

    Article  PubMed  Google Scholar 

  2. Mobbs RJ, Phan K, Malham G et al (2015) Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP. LLIF and ALIF J Spine Surg 1(1):2–18. https://doi.org/10.3978/j.issn.2414-469X.2015.10.05

    Article  PubMed  Google Scholar 

  3. Martin B I, Mirza S K, Spina N, et al (2019)Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976) 44(5): 369–376. https://doi.org/10.1097/BRS.0000000000002822.

  4. Keerthivasan P, Anupama NV, Kanna RM et al (2020) Lumbar artery pseudoaneurysm: a rare case of delayed onset incomplete cauda equina syndrome following transforaminal lumbar interbody fusion. Eur Spine J. https://doi.org/10.1007/s00586-020-06325-7

    Article  PubMed  Google Scholar 

  5. Domenicucci M, Ramieri A, Lenzi J et al (2008)Pseudo-aneurysm of a lumbar artery after flexion-distraction injury of the thoraco-lumbar spine and surgical realignment: rupture treated by endovascular embolization. Spine (Phila Pa 1976) 33(3): E81–E84. https://doi.org/10.1097/BRS.0b013e3181624b93.

  6. Nojiri H, Miyagawa K, Banno S et al (2016) Lumbar artery branches coursing vertically over the intervertebral discs of the lower lumbar spine: an anatomic study. Eur Spine J 25(12):4195–4198. https://doi.org/10.1007/s00586-016-4729-4

    Article  PubMed  Google Scholar 

  7. Zhao Q, Zhong E, Shi B et al (2020) Clinical anatomy and possible clinical significance of the postcentral branches of spinal arteries in the L1–L5 levels. Clin Spine Surg 33(8):328–332. https://doi.org/10.1097/BSD.0000000000000831

    Article  PubMed  Google Scholar 

  8. Ratcliffe JF (1980) The arterial anatomy of the adult human lumbar vertebral body: a microarteriographic study. J Anat 131(Pt 1):57–79

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Caglar S, Dolgun H, Ugur H C, et al (2004)Extraforaminal lumbar arterial anatomy. Surg Neurol 61(1): 29–33; discussion. https://doi.org/10.1016/s0090-3019(03)00541-x.

  10. Arslan M, Comert A, Acar H I, et al (2011)Surgical view of the lumbar arteries and their branches: an anatomical study. Neurosurgery 68(1 Suppl Operative):16–22; discussion. https://doi.org/10.1227/NEU.0b013e318205e307.

  11. Tatara Y, Nasu H, Tsutsumi M, et al (2019)Origins, courses, and distributions of the lumbar arterial branches in relation to the spinal nerves: an anatomical study. Spine (Phila Pa 1976) 44(14): E808-e14. https://doi.org/10.1097/BRS.0000000000003000.

  12. Willard FH, Vleeming A, Schuenke MD et al (2012) The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat 221(6):507–536. https://doi.org/10.1111/j.1469-7580.2012.01511.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Barker PJ, Freeman AD, Urquhart DM et al (2010) The middle layer of lumbar fascia can transmit tensile forces capable of fracturing the lumbar transverse processes: an experimental study. Clin Biomech (Bristol, Avon) 25(6):505–509. https://doi.org/10.1016/j.clinbiomech.2010.02.008

    Article  Google Scholar 

  14. Bradley L H, Paullus W C, Howe J, et al (2008)Isolated transverse process fractures: spine service management not needed. J Trauma, 2008, 65(4):832–836; discussion 6. https://doi.org/10.1097/TA.0b013e318184d30e.

  15. Bui TT, Nagasawa DT, Lagman C et al (2017) Isolated transverse process fractures and markers of associated injuries: the experience at University of California, Los Angeles. World Neurosurg 104:82–88. https://doi.org/10.1016/j.wneu.2017.04.137

    Article  PubMed  Google Scholar 

  16. Boulter JH, Lovasik BP, Baum GR et al (2016) Implications of Isolated transverse process fractures: is spine service consultation necessary? World Neurosurg 95:285–291. https://doi.org/10.1016/j.wneu.2016.08.027

    Article  PubMed  Google Scholar 

  17. Lombardo G, Petrone P, Prabhakaran K et al (2017) Isolated transverse process fractures: insignificant injury or marker of complex injury pattern? Eur J Trauma Emerg Surg 43(5):657–661. https://doi.org/10.1007/s00068-016-0745-7

    Article  CAS  PubMed  Google Scholar 

  18. Nagasawa DT, Bui TT, Lagman C et al (2017) Isolated transverse process fractures: a systematic analysis. World Neurosurg 100:336–341. https://doi.org/10.1016/j.wneu.2017.01.032

    Article  PubMed  Google Scholar 

  19. Denis F (1983)The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 8(8):817–831. https://doi.org/10.1097/00007632-198311000-00003.

  20. Liu L, Li N, Wang Q et al (2019) Iatrogenic lumbar artery injury in spine surgery: a literature review. World Neurosurg 122:266–271. https://doi.org/10.1016/j.wneu.2018.10.219

    Article  PubMed  Google Scholar 

  21. Oh YM, Choi HY, Eun JP (2013) Delayed retroperitoneal hemorrhage due to lumbar artery pseudoaneurysm after lumbar posterolateral fusion. J Korean Neurosurg Soc 54(4):344–346. https://doi.org/10.3340/jkns.2013.54.4.344

    Article  PubMed  PubMed Central  Google Scholar 

  22. Duncan JW, Bailey RA (2011) Cauda equina syndrome following decompression for spinal stenosis. Global Spine J 1(1):15–18. https://doi.org/10.1055/s-0031-1296051

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ahmad F, Turner SA, Torrie P et al (2008) Iatrogenic femoral artery pseudoaneurysms–a review of current methods of diagnosis and treatment. Clin Radiol 63(12):1310–1316. https://doi.org/10.1016/j.crad.2008.07.001

    Article  CAS  PubMed  Google Scholar 

  24. Stolt M, Braun-Dullaeus R, Herold J (2018) Do not underestimate the femoral pseudoaneurysm. Vasa 47(3):177–185. https://doi.org/10.1024/0301-1526/a000691

    Article  PubMed  Google Scholar 

  25. Lener S, Wipplinger C, Hernandez RN et al (2020) Defining the MIS-TLIF: a systematic review of techniques and technologies used by surgeons worldwide. Global Spine J 10(2 Suppl):151s–167s. https://doi.org/10.1177/2192568219882346

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This study has been supported by grants from The Science and Technology Project of Guangdong (Grant No. 2017B020210010). The study has been supported by grants from Natural Science Foundation of Guangdong (Grant No.2021A1515010864).

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Authors and Affiliations

  1. Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China

    Runxun Ma, Zhiyang Zheng, Xinying Zhou, Weijia Zhu, Junjie Chen, Rusen Zhang, Zexian Liu, Yejie Xu, Zezheng Liu, Qinghao Zhao & Qingchu Li

  2. Department of Spine Surgery, Nanhai Hospital, Southern Medical University, Nanhai District, 528244, Foshan, Guangdong, People’s Republic of China

    Maoqing Fu

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  1. Runxun Ma
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  2. Zhiyang Zheng
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  11. Qinghao Zhao
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Correspondence to Qinghao Zhao or Qingchu Li.

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The first three authors contributed equally to this work and should be considered as co-first authors.

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Ma, R., Zheng, Z., Zhou, X. et al. An anatomical study of the origins courses and distributions of the transverse branches of lumbar arteries at the L1–L4 levels. Eur Spine J 31, 678–684 (2022). https://doi.org/10.1007/s00586-022-07124-y

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  • DOI: https://doi.org/10.1007/s00586-022-07124-y

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