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The Use of Computed Tomography Angiography to Define the Prevertebral Vascular Anatomy Prior to Anterior Lumbar Procedures

Datta, Jason C., MD; Janssen, Michael E., DO; Beckham, Ruth, RN, BSN; Ponce, Caroline

doi: 10.1097/01.brs.0000250991.02387.84

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.

The role of preoperative computed tomography angiography with 3-dimensional reconstruction was evaluated in 76 consecutive patients who were being considered for an anterior approach to the spine. This study proved to be an effective and accurate preoperative tool for planning an anterior approach to the lumbar spine.

From the Spine Education Research Institute, Denver, CO.

Acknowledgment date: February 20, 2006. First revision date: March 13, 2006. Second revision date: March 16, 2006. Acceptance date: March 17, 2006.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Jason C. Datta, MD, Spine Education Research Institute, Suite #100, 9005 Grant Street, Denver, CO 80229; E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.