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Cho WJ, Kim KW, Park HY, Kim BH, Lee JS. Segmental artery injury during transforaminal percutaneous endoscopic lumbar discectomy: Two case reports. World J Clin Cases 2022; 10:12345-12351. [PMID: 36483795 PMCID: PMC9724518 DOI: 10.12998/wjcc.v10.i33.12345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Since Kambin experimentally induced arthroscopy to treat herniated nucleus pulposus, percutaneous endoscopic lumbar discectomy (PELD) has been developed. The branch of the segmental artery around the neural foramen may be damaged during PELD using the transforaminal approach. We report 2 rare cases in which segmental artery injury that occurred during PELD was treated with emergency embolization.
CASE SUMMARY In case 1, a 31-year-old man was transferred to our emergency department with left lower quadrant abdominal pain after PELD at a local hospital. Lumbar spine magnetic resonance imaging after the surgery showed a hematoma of the left retroperitoneal area and the psoas muscle area. Under suspicion of vascular injury, arteriography was performed. Pseudoaneurysm and blood leakage from the left 4th lumbar segmental artery into the abdominal cavity were identified. Emergency transarterial embolization was performed using fibered microcoils for bleeding of the segmental artery. In case 2, a 75-year-old woman was transferred to our emergency department with low blood pressure, right flank pain, and drowsy mental status after PELD at a local hospital. When the patient arrived at the emergency room, the blood pressure decreased from 107/55 mmHg to 72/47 mmHg. Low blood pressure persisted. Under suspicion of vessel injury, arteriography was performed, and the right 4th lumbar segmental artery rupture was confirmed. Emergency transarterial embolization was performed for bleeding of segmental artery.
CONCLUSION We were able to find the bleeding focus by angiography and treat the injury of the segmental artery successfully through emergency transarterial embolization.
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Affiliation(s)
- Wan-Jae Cho
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 07345, South Korea
| | - Ki-Won Kim
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 07345, South Korea
| | - Hyung-Youl Park
- Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 03312, South Korea
| | - Bo-Hyoung Kim
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 07345, South Korea
| | - Jun-Seok Lee
- Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 03312, South Korea
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Xu J, Fan S, Ni Y, Ngwayi JRM, Porter DE, Guo J. An anatomical feasibility study using CTA reconstruction for modified percutaneous lumbar vertebroplasty. BMC Musculoskelet Disord 2022; 23:693. [PMID: 35864497 PMCID: PMC9306169 DOI: 10.1186/s12891-022-05586-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/16/2022] [Indexed: 11/29/2022] Open
Abstract
Background 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. To investigate the anatomical feasibility of percutaneous vertebroplasty for lumbar osteoporotic vertebral compression fractures via a unilateral Extrapedicular approach. 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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Affiliation(s)
- Jianbiao Xu
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Orthopaedics Department, First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Shali Fan
- Radiology Department, First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Yu Ni
- Orthopaedics Department, First Affiliated Hospital of Tsinghua University, Beijing, China
| | | | - Daniel Edward Porter
- Orthopaedics Department, First Affiliated Hospital of Tsinghua University, Beijing, China.
| | - Jun Guo
- Orthopaedics Department, First Affiliated Hospital of Tsinghua University, Beijing, China.
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Ma R, Zheng Z, Zhou X, Zhu W, Chen J, Zhang R, Liu Z, Xu Y, Fu M, Liu Z, Zhao Q, Li Q. An anatomical study of the origins courses and distributions of the transverse branches of lumbar arteries at the L1-L4 levels. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:678-684. [PMID: 35094163 DOI: 10.1007/s00586-022-07124-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/05/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
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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Affiliation(s)
- Runxun Ma
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Zhiyang Zheng
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Xinying Zhou
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Weijia Zhu
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Junjie Chen
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Rusen Zhang
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Zexian Liu
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Yejie Xu
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Maoqing Fu
- Department of Spine Surgery, Nanhai Hospital, Southern Medical University, Nanhai District, 528244, Foshan, Guangdong, People's Republic of China
| | - Zezheng Liu
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Qinghao Zhao
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China.
| | - Qingchu Li
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China.
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