An anatomical feasibility study using CTA reconstruction for modified percutaneous lumbar vertebroplasty

Area of Science:

• Anatomy
• Interventional Radiology
• Medical Imaging

Background:

• Lumbar vertebroplasty offers clinical benefits but carries risks, notably lumbar artery (LA) injury.
• The anatomical basis for extrapedicular approach safety requires further exploration.
• Limited research exists on lumbar artery course and variability.

Purpose of the Study:

• To investigate the anatomical feasibility of percutaneous vertebroplasty for lumbar osteoporotic vertebral compression fractures.
• To evaluate the safety of a unilateral extrapedicular approach by analyzing lumbar artery anatomy.
• To identify safe zones for needle entry during lumbar vertebroplasty.

Main Methods:

• Retrospective analysis of 300 lumbar arteries (LAs) in 30 patients using computed tomographic angiography (CTA).
• Division of the lateral vertebral body aspect into 9 equal zones.
• Detailed analysis of LA anatomy, course, and orientation relative to vertebral zones.

Main Results:

• Lumbar arteries were most prevalent in the middle third of the vertebral body (zones 4-6).
• The postero-superior segment (zone 3) showed no artery presence.
• L1-L3 vertebrae exhibited an arched LA pattern, while L4 showed an inferior oblique pattern; L4 and L5 presented greater anatomical variation and visualization challenges.

Conclusions:

• The posterior superior segment (zone 1) of L1-L3 vertebrae is identified as a low-risk area for arterial injury.
• This finding is crucial for designing safer lumbar vertebral extrapedicular approaches.
• Understanding LA variations is key to enhancing the safety of percutaneous vertebroplasty.