Low back pain. Consider compromised blood supply

Blood Supply of the Lower Thoracic and Lumbosacral Regions

Postmortem aortography was performed in 38 adults, aged 17 to 29 years, to elucidate the normal anatomy of the arteries supplying the lower thoracic and lumbosacral regions. The lowest 3 thoracic segmental arteries, examined in 32 cases, ran symmetrically in 27 cases. In 5 cases (16%) their course was asymmetric; on one side every segment was fed by an artery of its own, whereas on the other side a segmental artery fed 2 or more segments. The course, distribution and size of the 1st to 4th lumbar arteries were constant in every case except one, while the middle sacral artery and its branches, the 5th lumbar arteries, varied in size, being frequently compensated for, partly or wholly, by the iliolumbar arteries derived from the internal iliac arteries. In their course around the vertebral bodies, lumbar arteries frequently passed between and beneath fibrous attachments of the crura of the diaphragm and the psoas muscle.

Postmortem angiographic study of degenerative vascular changes in arteries supplying the cervicobrachial region

OBJECTIVES

To study the prevalence of degenerative changes in the arteries supplying the cervicobrachial region, and their relation to cervical disc degeneration.

METHODS

Fifty postmortem aortic arch angiographies were evaluated for occlusions and variations in the diameter of the vertebral arteries and thyro- and costocervical trunks, as well as for tortuosity, average diameter and the highest cervical level to which the ascending cervical artery, an upward continuation of the thyrocervical trunk, and the deep cervical artery, an upward continuation of the costocervical trunk, ascended.

RESULTS

Localised segmental narrowings, usually situated close to the ostia of the arteries, were common, whereas total occlusions were rare. Thirty (60%) of the subjects showed a segmental narrowing at least in one of the six arteries analysed, while only two (4%) showed an occluded artery, which in both the cases was the thyrocervical trunk. Narrowings were most common in vertebral arteries, followed by costocervical and thyrocervical trunks. Segmental narrowings, as well as general tortuosity of the arteries, increased with age. It was also found that ascending and deep cervical arteries did not run as high up in the posterior neck muscles in older people as in younger ones. Twenty three subjects with marked cervical disc degeneration showed on average 2.3 arteries with segmental narrowings, while the corresponding figure for twenty seven subjects without disc degeneration was 0.6. Both the segmental narrowings and the disc degeneration, however, were strongly associated with age, and thus the causality between the former two remained unclear.

CONCLUSION

The study showed that degenerative changes are common in the arteries supplying the cervicobrachial area, indicating that impaired blood flow might play a part in some cervicobrachial disorders.