3D Reconstructions of Spinal Segmental Arteries Using CT Angiography: Applications in Minimally Invasive Spinal Procedures

• Published in: American journal of neuroradiology : AJNR Vol. 31; no. 9; pp. 1635 - 1639
• Main Authors: HEO, D. H, CHO, Y. J, SHEEN, S. H, HONG, M. S, CHO, S. M, PARK, S. H
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL American Society of Neuroradiology 01-10-2010
• Subjects: Aged; Angiography - methods; Biological and medical sciences; Female; Humans; Imaging, Three-Dimensional - methods; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Minimally Invasive Surgical Procedures - methods; Nervous system; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Orthopedic Procedures - methods; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiographic Image Interpretation, Computer-Assisted - methods; Reproducibility of Results; Sensitivity and Specificity; Spinal Cord - blood supply; Spinal Cord - diagnostic imaging; Spinal Cord - surgery; Spine; Surgery, Computer-Assisted - methods; Nervous system diseases; Radiodiagnosis; Segmental; Spinal artery; Tridimensional image; Spinal angiography; Angiocomputed tomography; Image reconstruction
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a2137

Injury to spinal segmental arteries may potentially occur during spinal surgery, particularly during anterior or minimally invasive approaches. Use of a noninvasive radiologic tool to evaluate these arteries before surgery may reduce this risk.
We performed spinal CT angiography and reconstructed 3D images of segmental arteries in 41 patients. We classified the pathways and locations of the segmental arteries into 4 zones (A, B, C, and D) according to pedicle and vertebral endplates. We designated segmental arteries from T8 to L1 as "high-level segmental arteries" and those from L2 to L4, as "low-level segmental arteries." We compared the distribution of segmental arteries between these 2 groups. We also investigated anatomic variations of segmental arteries and the rate of occurrence of the artery of Adamkiewicz.
In all patients, 3D reconstruction images from spinal CT angiography clearly showed the pathways of segmental arteries on the vertebral bodies. Most of the segmental arteries passed the middle portion of the vertebral body (zones B and C). However, 51 of 738 segmental arteries (6.9%) had uncommon pathways (zones A and D), and segmental arteries from L2 to L4 had a higher incidence of uncommon pathways than higher level vertebrae (P < .05). We also observed 2 types of segmental artery anatomic variation, agenesis and dual supply.
We suggest that spinal CT angiography can help to precisely visualize the spinal segmental arteries and surrounding bony structures and can aid clinicians in deciding on optimal approaches for spinal surgery.