Anatomical Evaluation of Celiac Artery and Median Arcuate Ligament Displacement During Spinal Corrective Procedures:
Takahiro Ushimaki1,2, Hidetoshi Nojiri3,2, Shota Tamagawa1,2
1Department of Orthopedics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Background:
Celiac artery compression syndrome (CACS) is a rare but potentially life-threatening complication of spinal deformity correction. Although prior reports have suggested an association between spinal correction and vascular compression, the underlying anatomical mechanisms remain unclear. This study aimed to investigate the positional changes in the celiac artery and median arcuate ligament (MAL) during spinal corrective procedures using a cadaveric model.
Methods:
A human cadaver preserved using the Thiel method was used to simulate anterior extension correction via Smith-Petersen osteotomy (SPO) at the T12/L1 and L3/L4 levels and posterior shortening via pedicle subtraction osteotomy (PSO) at L1, each with a 30° correction angle. The T12/L1 and L3/L4 levels were located proximal and distal to the origin of the diaphragmatic crura, respectively. Pre- and postoperative computed tomography was conducted to measure the vertical and anteroposterior distances between the celiac artery and the MAL, with the anterior-inferior border of the 12th thoracic vertebra as a fixed reference point.
Results:
The vertical distances between the celiac artery and the MAL were 8.8 mm before correction, 2.6 mm after T12/L1 SPO, 9.3 mm after L3/L4 SPO, and 11.5 mm after L1 pedicle subtraction osteotomy. The corresponding horizontal distances were 6.6 mm, 11.3 mm, 8.2 mm, and 5.8 mm. Notably, SPO at T12/L1-proximal to the origin of the diaphragmatic crus-resulted in the greatest reduction in vertical distance.
Conclusion:
Anterior extension correction at the thoracolumbar junction significantly reduced the distance between the celiac artery and the MAL. These positional changes may contribute to the development of iatrogenic CACS. Surgeons should exercise caution when performing anterior correction near the diaphragmatic crus to minimize this vascular risk.
Clinical Relevance:
Anterior correction at the thoracolumbar junction, particularly at T12/L1, significantly shortens the distance between the MAL and the celiac artery, increasing the risk of vascular compression. Patients with a short MAL-celiac artery distance may be more susceptible to developing CACS. To prevent this potentially fatal complication, preoperative imaging and anatomically informed surgical planning are essential.
