Recent years have witnessed considerable advances in the surgical techniques for treatment of adult spinal deformity (ASD). It is now possible to achieve a large lumbar lordosis using lateral lumbar interbody fusion (LLIF) [[1], [2], [3]]. Unlike posterior vertebral osteotomy, LLIF, which is anterior spinal extension surgery, may cause traction of blood vessels and abdominal organs. However, a few reports have investigated the occurrence of acute celiac artery compression syndrome (ACACS) after spinal deformity surgery involving the upper lumbar spine [[4], [5], [6]].

ACACS may occur to the compression of the median arcuate ligament (MAL) which lies between the left and right diaphragmatic crura [7]. In the absence of adequate remedial measures, ACACS can lead to ischemic necrosis of the foregut abdominal organs. Although ACACS is mainly caused by intraabdominal lesions, it may also occur due to correction of spinal kyphosis that causes a change in the anatomical relation between the MAL and the celiac artery (CA). Kotani et al. highlighted the triple compression signs, i.e., narrowing of the CA, the superior mesenteric artery (SMA), and the abdominal aorta [5]. The rate and factors associated with CA stenosis preoperatively have not yet been known. Knowing the factors might prevent overcorrection and reduce ACACS.

The aim of the current study was to investigate the anatomical relationship between the spine, the CA, and the MAL using preoperative images in patients with spinal deformity who underwent surgery.