Analysis of the relationship between spinal alignment and retrocrural space area in adult spinal deformity surgery: Potential risk factors for acute celiac artery compression syndrome

Spinal correction surgery is a reliable treatment option to improve the health-related quality of life for patients with adult spinal deformities (ASD) [[1], [2], [3]]. However, spinal correction surgery risks serious complications, such as major vascular and visceral injuries [[4], [5], [6]]. Several studies reported that acute celiac artery compression syndrome (ACACS) due to compression of the origin of the celiac artery (CA) by the median arcuate ligament (MAL) may occur after spinal correction surgery [[7], [8], [9], [10], [11], [12]]. This is a rare but life-threatening complication. Although the detailed pathophysiology is not well-known, it is thought that ACACS has a wide range of pathophysiology with only the most severe cases developing overt symptoms. In other words, there might be ACACS patients with only mild or no symptoms [7].

The pathophysiology of ACACS may be associated with anatomical changes of the MAL, the origin of the CA, and/or the alignment of the thoracolumbar spine due to the correction [7,9]. The MAL is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus [[13], [14], [15]], and usually is located at the level of the T12 or L1 vertebral body [13]. The retrocrural space (RCS) is a triangular region representing the most inferior portion of the posterior mediastinum. It is delimited anteriorly and laterally by the MAL, and posteriorly by the anterior wall of the vertebra (Fig. 1) [16,17]. The RCS includes various structures, such as the aorta and sympathetic trunks [16,17]. The RCS includes the origin of the CA in 24%–43.37% of the population [18,19]. If the MAL compresses the origin of the CA, simultaneous narrowing of the RCS occurs. Therefore, if spinal alignment changes after spinal correction surgery, the RCS area might change. However, the association between the RCS change and spinal alignment change in patients with ASD treated by spinal correction surgery is not well-known.

This study aimed to elucidate the association between spinal parameters and RCS area in patients with ASD treated with spinal correction surgery and to reveal the pathogenesis of ACACS. We hypothesized that reduction of the RCS area is related to thoracolumbar alignment, which causes ACACS.

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