Effect of segmental artery ligation on the blood supply of the thoracic spinal cord during anterior spinal surgery: a quantitative histomorphological fresh cadaver study.
ABSTRACT Human cadaver quantitative morphometric analysis of the blood vessels in the spinal cord after ligation of segmental arteries.
To investigate the effect of ligation of segmental arteries on the quantity and density of the blood vessels in the spinal cord.
Ligation of segmental arteries is often used in the anterior approach for correction scoliosis. However, whether or not segmental artery ligation is liable to deny the spinal cord an adequate blood supply, thus leading to paraplegia, still remains controversial.
Eleven fresh cadavers were divided into control, unilateral, and bilateral groups. For the unilateral and bilateral groups, 5 segmental vertebral arteries (T7-T11) were ligated unilaterally and bilaterally, respectively. Then, the number and density of blood vessels at different levels in the 3 groups were measured.
Compared to that of the corresponding level in the control group, the number of blood vessels at T5 to L1 all decreased in the ligation groups. And significant differences were found at T8 (82.80 +/- 16.36), T10 (77.80 +/- 19.80), and T11 (99.20 +/- 14.85) levels, compared to those of the corresponding levels in the control group: T8 (175.80 +/- 8. 31), T9 (176.40 +/- 32. 33), T10 (171.40 +/- 9. 73), and T11 (189.20 +/- 15. 92). Further decrease was found at each corresponding level in the bilateral group, and significant differences were found at T8 (65.80 +/- 15.55), T9 (24.80 +/- 13.43), T10 (0), T11 (0), and T12 (0) levels. Similar results were obtained with regard to the density of blood vessels. Significant differences were found at T11 (1.246 +/- 0.112) and L1 (1.349 +/- 0.109) in the unilateral group, and T9 (0.260 +/- 0.088), T10 (0), T11 (0), T12 (0), and L1 (0.147 +/- 0.117) in the bilateral group compared to those of the corresponding levels in the control group: T9 (1.810 +/- 0.202), T10 (1.833 +/- 0.175), T11 (2.308 +/- 0.335), T12 (2.510 +/- 0.617), and L1 (2.193 +/- 0.033).
This study suggests that the more levels the ligation encompasses, the higher the risk of spinal cord damage. Therefore, caution should be taken when several segmental arteries are to be ligated in the clinical setting. What is more, bilateral ligation, which is worse than unilateral ligation, can lead to a significant decrease in the number and density of blood vessels of the spinal.
- [Show abstract] [Hide abstract]
ABSTRACT: Further evidence of the importance of segmental vessel ligation in the development of neurological complications has been recently published. The more levels the ligation encompasses, the higher the risk of spinal cord damage. Therefore, caution should be taken when several segmental arteries are to be ligated in the clinical setting. To prevent ligation of segmental vessels during convex growth arrest surgery and thus decrease the risk of spinal cord ischemia and neurological injury. A report of a modified technique of convex growth arrest surgery used in two consecutive patients in our unit. In two consecutive patients the segmental vessels were mobilized, elevated, and protected by using surgical slings. The rib graft was then slid beneath the elevated vessels into the prepared vertebral body channel and punched into place. The pleura then closed over the rib graft and spared vessels. Three of the five segmental vessels in the first patient were spared. All five segmental vessels were spared in the second patient. No neurological complications occurred. We report a straightforward technique, which obviates the need for segmental vessel ligation, and therefore decreases the risk of neurological injury in an already high-risk group.The Spine Journal 01/2007; 7(3):349-52. · 3.36 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: This study introduced an anatomical basis for thoracoscope-assisted thoracolumbar spinal anterior approach. This work was carried out in terms of 29 corpse specimens anatomizing and the CT three-dimensional images of 25 normal adults observing. The observation by the thoracolumbar spine side of the adult corpse specimens showed that the segmental arteries and veins constantly existed and ran in the central supersulcus of the corresponding vertebral body's side; the segmental artery had several branches; the zone between the upper and lower segmental arteries formed a relative non-vascular nerve safe zone, where the intervertebral space(disc) located. And the observation of the three-dimensional CT image indicated that the segmental arteries were visible and ran in the central supersulcus of the corresponding vertebral body's side, while the branches were invisible. Besides, the arrangement and distribution of the segmental arteries on the three-dimensional CT images and the result were basically consistent with that on corpse specimens. The safe zone, with the intervertebral disc as the reference mark, could provide enough operation space for surgeries such as thoracoscope-assisted anterior interbody fusion and reduce damage to blood vessels as well as surgical complications.Anatomia Clinica 03/2011; 33(2):117-22. · 0.93 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND CONTEXT: The understanding of vascular supply to the spinal cord is important given that the evolution of surgical approaches to the spine may bring along the potential for more frequent complications, especially a rare but devastating complication: that of spinal cord ischemia or infarction. To maximally avoid this complication, the relationship between the spinal cord vascularity and the anterior spine surgical approach needs further study. PURPOSE: To provide a theoretical basis that will allow the spinal surgeon to take appropriate steps to avoid spinal cord ischemia during anterior spinal surgery through anatomic means. STUDY DESIGN: Spinal cord vascular casting assessment with cadaveric specimen. METHODS: Twenty adult cadaveric specimens (11 men and 9 women) were obtained for the latex perfusion and vessel dissection. In addition, nine patients (seven men and two women) underwent superselective angiography of the spinal cord. The segmental arterial anastomosis and radiculomedullary vessels in the thoracolumbar region were shown and reviewed. RESULTS: There were approximately 21 pairs of segmental arteries in the thoracolumbar region. Adjacent segmental arteries were networked with each other. The latex infusion specimens demonstrated 72 anterior radiculomedullary arteries and 177 posterior radiculomedullary arteries in all 20 samples. The anterior and posterior spinal arteries were also networked with each other at several levels. Superselective spinal angiography was consistent with the latex infusion specimens showing. CONCLUSIONS: The variety of anatomy of spinal cord arterial networks is shown, and the relation between the blood supply of certain spinal levels and the potential ischemic complications during the anterior surgical approach is discussed. It is hopefully of benefit to surgeons, after fully understanding the anatomy of these spinal vascular supply structures, that there may be even greater avoidance of vascular compromise in these challenging operations.The spine journal: official journal of the North American Spine Society 04/2013; · 2.90 Impact Factor