Background:

Vascular injury to the lumbar segmental arteries is a devastating complication in minimally invasive lumbar interbody fusion. Previous studies on the anatomy of the lumbar segmental arteries are limited. This prospective cross-sectional study aims to quantitatively describe the brief trajectory of the lumbar segmental arteries on the left side (SegAL) and to discuss its clinical significance.

Methods:

One hundred and two asymptomatic volunteers were prospectively enrolled and underwent computed tomography angiography (CTA). Anatomical parameters including the existence rate, relative positions and directions of SegAL were measured. Mann-Whitney U tests were performed, and statistical significance was set at P<0.05.

Results:

A total of 404 lumbar SegAL were identified. The SegAL of L1, L2 and L3 were identified in all subjects while the L4 SegAL were absent in 9 of 102 (8.8%) and the L5 SegAL were absent in 97 of 102 (95.1%) volunteers. In 25 of 97 (25.8%) volunteers without the L5 SegAL, the branches of the L4 SegAL ran along the disks. Meanwhile, the branches of L3 intersecting over the intervertebral discs (IVD) were found in 8 of 9 (88.9%) subjects without the L4 SegAL and in 4 of 93 (4.3%) subjects with L4 SegAL. The branch angles between the L1, L2 SegAL and the aorta were significantly acute (P<0.05). The L3 SegAL ran approximately vertically with the aorta while the branch angles of the L4 SegAL were significantly blunt (P<0.05). according to the distances measured, on the anterior vertebral walls, the SegAL of L1 and L2 were significantly closer to the inferior vertebral walls than the SegAL of L3 and L4, while on the posterior vertebral walls, the L3 and L4 SegAL were significantly closer to the inferior walls.

Conclusions:

Arterial branches may course over the L3-4 and L4-5 IVD spaces and the branches over the L3-4 disks are more likely to be present when L4 segmental arteries are absent, thus posing potential risks of arterial complications. Because of the SegAL adjacent to the disks, the risk of arterial injury may be higher anteriorly at L1 and L2 and higher posteriorly at L3 and L4.