The use of computed tomography angiography to define the prevertebral vascular anatomy prior to anterior lumbar procedures

Abstract

Study design: Prospective cohort.

Objective: To determine the efficacy of a single-slice computed tomography (CT) angiogram to define the prevertebral anatomy in patients undergoing an anterior lumbar spine procedure.

Summary of background data: Preoperative planning with precise prevertebral anatomic details can help in mini-open anterior lumbar approaches.

Methods: A total of 76 consecutive patients undergoing a minimal incision approach for anterior lumbar surgery were evaluated before surgery with CT angiography. The prevertebral anatomy was documented, and the patients were observed during treatment.

Results: There were no complications related to CT angiography. This study directly influenced surgical decision making and the treatment options in 21% of patients. The vena caval confluence limited access to the L5-S1 disc in 3% of patients and at the L4-L5 disc in 92% of the patients. Prevertebral anatomic anomalies were found in 11.8% of patients. Atherosclerotic disease was discovered in 17% of the patients. The major complication rate was 7.5%. CT angiography correlated with intraoperative vascular anatomy in all cases.

Conclusion: Preoperative CT angiography before anterior approaches was determined to be effective in evaluating the prevertebral vascular anatomy.