Abstract：Objective To explore the anatomy of lumbar segmental arteries and its research progress in minimally invasive lumbar spine surgery. Methods "腰椎节段动脉/lumbar segmental artery""腹膜后血肿/retroperitoneal hematoma" and "医源性损伤/iatrogenic injury" were used as key words to identify articles about the anatomy of lumbar segmental arteries in CNKI, Wanfang, Weipu, and PubMed database from January 1996 to August 2021. We searched literatures related to the anatomy of lumbar segmental arteries, anterior lumbar interbody fusion, lateral lumbar interbody fusion, percutaneous vertebroplasty, and percutaneous endoscopic lumbar discectomy. A total of 153 literatures were searched, and 40 literatures were finally included after excluding the literatures that did not met the inclusion criteria. Among them, three were written in Chinese, and 37 were written in English. Then, we summarized the risks of lumbar segmental artery injuries in these minimally invasive lumbar spine surgeries and the coping strategies. Results Lumbar segmental arteries are often composed of four pairs of arteries (L1–L4) and/or L5 artery. The source L5 segmental artery has more variabilities and has a lower presence rate. Injuries to the lumbar segmental arteries during iatrogenic procedure may cause serious consequences including bleeding, retroperitoneal hematoma, and spinal infarction. Conclusion During spinal surgery, injuries of lumbar segmental arteries are uncommon but can cause serious life-threatening consequences if they occur. As surgeons, having a detailed operation plan before surgery, understanding the anatomical position, carefully conducting the surgical procedures, observing the patients, and having contingency plans to control artery bleeding are very important.
伍宇轩, 包贝西, 闫辉, 唐家广. 腰椎微创手术中腰椎节段动脉损伤的研究进展[J]. 中华解剖与临床杂志, 2022, 27(6): 444-448.
Wu Yuxuan, Bao Beixi, Yan Hui, Tang Jiaguang. Research progress on lumbar segmental arteries injury during mis-invasive lumbar spine surgery. Chinese Journal of Anatomy and Clinics, 2022, 27(6): 444-448.
Ravindra VM, Senglaub SS, Rattani A, et al.Degenerative lumbar spine disease: estimating global incidence and worldwide volume[J]. Global Spine J, 2018,8(8):784-794. DOI: 10.1177/2192568218770769.
[2]
董文兰, 李镒冲, 刘世炜, 等. 1990与2013年中国人群腰背痛疾病负担分析[J].中华预防医学杂志,2017,51(2):132-136. DOI: 10.3760/cma.j.issn.0253-9624.2017.02.007.Dong WL, Li YC, Liu SW, et al.The disease burden for low back pain in China, 1990 and 2013[J]. Chin J Prev Med,2017, 51(2): 132-136. DOI: 10.3760/cma.j.issn.0253-9624.2017.02.007.
[3]
Koenders N, Rushton A, Verra ML, et al.Pain and disability after first-time spinal fusion for lumbar degenerative disorders: a systematic review and meta-analysis[J]. Eur Spine J, 2019, 28(4):696-709. DOI: 10.1007/s00586-018-5680-3.
[4]
Försth P, Ólafsson G, Carlsson T, et al.A randomized, controlled trial of fusion surgery for lumbar spinal stenosis[J]. N Engl J Med, 2016,374(15):1413-1423. DOI: 10.1056/NEJMoa1513721.
[5]
Smuck M, Muaremi A, Zheng P, et al.Objective measurement of function following lumbar spinal stenosis decompression reveals improved functional capacity with stagnant real-life physical activity[J]. Spine J, 2018,18(1):15-21. DOI: 10.1016/j.spinee.2017.08.262.
[6]
Ventura F, Barranco R, Bernabei C, et al.A fatal and unusual iatrogenic fourth right lumbar artery injury complicating wrong-level hemilaminectomy: a case report and literature review[J]. Br J Neurosurg, 2019,33(4):434-436. DOI: 10.1080/02688697.2017.1351523.
[7]
Robertson SC, Shaikh Y, Sharif S.Perspective on variation in lumbar segmental arteries and their importance on oblique lateral interbody fusion[J]. World Neurosurg, 2020,139:453-455. DOI: 10.1016/j.wneu.2020.04.020.
[8]
Harrington JF.Far lateral disc excision at L5-S1 complicated by iliolumbar artery incursion: case report[J]. Neurosurgery, 2001,48(6):1377-1380. DOI: 10.1097/00006123-200106000-00045.
[9]
Al Talalwah W, Al Dorazi SA, Soames R.The origin variability of the iliolumbar artery and iatrogenic sciatica[J]. Eur J Orthop Surg Traumatol, 2015,25(Suppl 1):S199-S204. DOI: 10.1007/s00590-014-1548-3.
[10]
Orita S, Inage K, Sainoh T, et al.Lower lumbar segmental arteries can intersect over the intervertebral disc in the oblique lateral interbody fusion approach with a risk for arterial injury: radiological analysis of lumbar segmental arteries by using magnetic resonance imaging[J]. Spine (Phila Pa 1976), 2017,42(3):135-142. DOI: 10.1097/BRS.0000000000001700.
[11]
Susan Standring.Gray's Anatomy[M]. 42nd Edition. Amsterdam:Elsevier, 2020: 1137-1149.
[12]
Arslan M, Comert A, Acar HI, et al.Surgical view of the lumbar arteries and their branches: an anatomical study[J]. Neurosurgery, 2011,68(1 Suppl Operative):16-22. DOI: 10.1227/NEU.0b013e318205e307.
[13]
Biglioli P, Roberto M, Cannata A, et al.Upper and lower spinal cord blood supply: the continuity of the anterior spinal artery and the relevance of the lumbar arteries[J]. J Thorac Cardiovasc Surg, 2004,127(4):1188-1192. DOI: 10.1016/j.jtcvs.2003.11.038.
[14]
Kiil BJ, Rozen WM, Pan WR, et al.The lumbar artery perforators: a cadaveric and clinical anatomical study[J]. Plast Reconstr Surg, 2009,123(4):1229-1238. DOI: 10.1097/PRS.0b013e31819f299e.
[15]
Nakashima H, Kanemura T, Satake K, et al.Patient-reported quality of life following posterior lumbar interbody fusion or indirect decompression using lateral lumbar interbody fusion[J]. Spine (Phila Pa 1976), 2020,45(18):E1172-E1178. DOI: 10.1097/BRS.0000000000003535.
[16]
庞瑶, 范云鹏, 李茂强,等. 斜外侧入路与后入路椎体融合术治疗腰椎退行性疾病临床疗效的Meta分析[J]. 中华解剖与临床杂志, 2020, 25(3):7. DOI: 10.3760/cma.j.cn101202-20190524-00172Pang Y, Fan YP, Li MQ, et al.Clinical efficacy of oblique lateral interbody fusion and posterior lumbar interbody fusion for lumbar degenerative diseases: a Meta-analysis[J]. Chin J Anat Clin, 2020, 25(3): 308-314. DOI: 10.3760/cma.j.cn101202-20190524-00172.
[17]
Manzur M, Virk SS, Jivanelli B, et al.The rate of fusion for stand-alone anterior lumbar interbody fusion: a systematic review[J]. Spine J, 2019,19(7):1294-1301. DOI: 10.1016/j.spinee.2019.03.001.
[18]
Manzur MK, Steinhaus ME, Virk SS, et al.Fusion rate for stand-alone lateral lumbar interbody fusion: a systematic review[J]. Spine J, 2020, 20(11):1816-1825. DOI: 10.1016/j.spinee.2020.06.006.
[19]
Samudrala S, Khoo LT, Rhim SC, et al.Complications during anterior surgery of the lumbar spine: an anatomically based study and review[J]. Neurosurg Focus, 1999,7(6):e9. DOI: 10.3171/foc.1999.7.6.10.
[20]
Kieffer E, Fukui S, Chiras J, et al.Spinal cord arteriography: a safe adjunct before descending thoracic or thoracoabdominal aortic aneurysmectomy[J]. J Vasc Surg, 2002,35(2):262-268. DOI: 10.1067/mva.2002.120378.
[21]
Takase K, Sawamura Y, Igarashi K, et al.Demonstration of the artery of Adamkiewicz at multi- detector row helical CT[J]. Radiology, 2002, 223(1): 39-45. DOI: 10.1148/radiol.2231010513.
[22]
Lo D, Valleé JN, Spelle L, et al.Unusual origin of the artery of Adamkiewicz from the fourth lumbar artery[J]. Neuroradiology, 2002,44(2):153-157. DOI: 10.1007/s002340100658.
[23]
Winter RB, Lonstein JE, Denis F, et al.Paraplegia resulting from vessel ligation[J]. Spine (Phila Pa 1976), 1996,21(10):1232-1234. DOI: 10.1097/00007632-199605150-00017.
[24]
Griepp RB, Ergin MA, Galla JD, et al.Looking for the artery of Adamkiewicz: a quest to minimize paraplegia after operations for aneurysms of the descending thoracic and thoracoabdominal aorta[J]. J Thorac Cardiovasc Surg,1996,112(5):1202-1215. DOI: 10.1016/s0022-5223(96)70133-2.
[25]
Wu T, Xiao L, Liu C, et al.Anatomical study of the lumbar segmental arteries in relation to the oblique lateral interbody fusion approach[J]. World Neurosurg, 2020, 138: e778-e786. DOI: 10.1016/j.wneu.2020.03.080.
[26]
Tezuka F, Sakai T, Nishisho T, et al.Variations in arterial supply to the lower lumbar spine[J]. Eur Spine J, 2016,25(12):4181-4187. DOI: 10.1007/s00586-016-4427-2.
[27]
Grasso G.Avoiding lumbar segmental arteries injury in oblique lateral interbody fusion procedure[J]. World Neurosurg, 2020, 139:57-59. DOI: 10.1016/j.wneu.2020.03.161.
[28]
Santillan A, Patsalides A, Gobin YP.Endovascular embolization of iatrogenic lumbar artery pseudoaneurysm following extreme lateral interbody fusion (XLIF)[J]. Vasc Endovascular Surg, 2010,44(7):601-603. DOI: 10.1177/1538574410374655.
[29]
Takata Y, Sakai T, Tezuka F, et al.Risk assessment of lumbar segmental artery injury during lateral transpsoas approach in the patients with lumbar scoliosis[J]. Spine (Phila Pa 1976), 2016,41(10):880-884. DOI: 10.1097/BRS.0000000000001362.
[30]
Puri AS, Colen RR, Reddy AS, et al.Lumbar artery pseudoaneurysm after percutaneous vertebroplasty: a unique vascular complication[J]. J Neurosurg Spine, 2011,14(2):296-299. DOI: 10.3171/2010.10.SPINE1082.
[31]
Biafora SJ, Mardjetko SM, Butler JP, et al.Arterial injury following percutaneous vertebral augmentation: a case report[J]. Spine (Phila Pa 1976), 2006,31(3): E84-E87. DOI: 10.1097/01.brs.0000197596.88416.02.
[32]
Heo DH, Cho YJ.Segmental artery injury following percutaneous vertebroplasty using extrapedicular approach[J]. J Korean Neurosurg Soc, 2011,49(2):131-133. DOI: 10.3340/jkns.2011.49.2.131.
[33]
Liu L, Cheng S, Lu R, et al.Extrapedicular infiltration anesthesia as an improved method of local anesthesia for unipedicular percutaneous vertebroplasty or percutaneous kyphoplasty[J]. Biomed Res Int, 2016,2016:5086414. DOI: 10.1155/2016/5086414.
[34]
Ahn Y, Kim JU, Lee BH, et al.Postoperative retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy[J]. J Neurosurg Spine, 2009,10(6):595-602. DOI: 10.3171/2009.2.SPINE08227.
[35]
王华锋, 周福山, 温冰涛,等. 经皮椎间孔镜下腰椎间盘切除术后腹膜后血肿三例报道并文献复习[J]. 中华解剖与临床杂志, 2019, 24(1): 65-70. DOI:10.3760/cma.j.issn.2095-7041.2019.01.012.Wang HF, Zhou FS, Wen BT, et al.Retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy: 3 cases reports and literature review[J]. Chin J Anat Clin, 2019,24(1): 65-70. DOI: 10.3760/cma.j.issn.2095-7041.2019.01.012.
[36]
Gioffrè G, Impusino A, Tacconi L.Retroperitoneal hematoma after minimally invasive lumbar discectomy: is the percutaneous endoscopic approach really safe?[J]. J Neurosurg Sci, 2019,63(2):231-233. DOI: 10.23736/S0390-5616.17.04156-X.
[37]
Baea DH, Eunb SS, Lee SH, et al.Two cases of retroperitoneal hematoma after transforaminal percutaneous endoscopic lumbar discectomy[J]. Interdisciplinary Neurosurgery,2019, 20:100649. DOI: 10.1016/j.inat.2019.100649.
[38]
Ito T, Ishikawa E, Ito M.Lumbar artery injury following renal biopsy[J]. Clin Exp Nephrol, 2016,20(1):145-146. DOI: 10.1007/s10157-015-1157-4.
[39]
Álvarez Postigo M, Pizones Arce J, Izquierdo Núñez E.Lumbar segmental artery pseudoaneurysm after L5 pedicle screw placement. A rare vascular complication[J]. Rev Esp Cir Ortop Traumatol, 2017,61(6):436-440. DOI: 10.1016/j.recot.2017.06.003.
[40]
Ikeda O, Kawanaka K, Nakasone Y, et al.Direct percutaneous embolization of an iatrogenic lumbar artery pseudoaneurysm following unsuccessful coil embolization[J]. Acta Radiol, 2012, 53(5):541-544. DOI: 10.1258/ar.2012.110210.
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