Acute celiac artery compression syndrome (ACACS) after spinal deformity surgery is a rare, but life-threatening complication resulting in ischemic necrosis of the abdominal organs, including the duodenum, liver, gallbladder, pancreas, and spleen, due to obstruction of the celiac artery (CA) by the median arcuate ligament (MAL) [[1], [2], [3], [4], [5], [6], [7]]. The pathogenesis of ACACS in spine surgery has been reported as a narrowing of the celiac artery between the MAL and the lordotic vertebrae in the thoracolumbar region [[1], [2], [3]]. Additionally, stenoses of the superior mesenteric artery (SMA) and aorta, in addition to the stenosis of CA, known as the “triple compression sign,” can be fatal due to failure of multiple organs [1].

The pathogenesis that can cause ACACS after spinal surgery includes lordosis restoration of the thoracolumbar region. Previous case reports have described the development of ACACS in combined anterior–posterior surgeries using the lateral interbody fusion (LIF) technique [1,2,7]. The strong corrective force by combined anterior and posterior surgery is related to the onset of ACACS [[1], [2], [3]]. To supply blood to the organs, the CA essentially branches off from the aorta caudal to the MAL. However, even in the general population, the CA can be compressed by the MAL overlapping the CA due to the relative caudal position of the MAL or the relative cephalic position of the CA [8,9] (Fig. 1).

The preoperative vascular anatomy of the patient's CA may be associated with the development of ACACS. For example, coronary artery calcification is one factor that predicts the development of ischemic heart disease [10]. Thus, in spine surgery, preoperative evaluation of CA and SMA stenosis is important because preoperative stenosis can cause postoperative ACACS. The prevalence of asymptomatic CA stenosis in the general population has been studied in the gastroenterology [8,9]. However, to our knowledge, no studies to date have yet reported the prevalence and risk factors for CA and SMA stenosis in preoperative spinal patients.

Here, using contrast-enhanced abdominal computed tomographic (CT) images we sought to determine the degree of stenosis of the CA and SMA in spinal patients preoperatively. We also determined the prevalence of patients with the stenosis, and the risk factors associated with CA stenosis.