Temporary liver and stomach necrosis after lateral approach for interbody fusion and deformity correction of lumbar spine: report of two cases and review of the literature

Introduction Corrections of spinal deformities have been associated with a potential of postoperative vessel-originating complications. Reports of occlusions of celiac artery seem though to be very rare. Case reports We present two cases that developed acute arterial supply impairment and subsequent...

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Bibliographic Details
Published in:European spine journal 2016-05, Vol.25 (Suppl 1), p.257-266
Main Authors: Vasiliadis, Haris S., Teuscher, Regula, Kleinschmidt, Mark, Marrè, Susanne, Heini, Paul
Format: Article
Language:English
Subjects:
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Arterial Occlusive Diseases - diagnostic imaging
Arterial Occlusive Diseases - etiology
Case Report
Celiac Artery - diagnostic imaging
Female
Humans
Ischemia - diagnostic imaging
Ischemia - etiology
Kyphosis - diagnostic imaging
Kyphosis - surgery
Liver - blood supply
Liver - diagnostic imaging
Liver - pathology
Lumbar Vertebrae - diagnostic imaging
Lumbar Vertebrae - surgery
Male
Medicine
Medicine & Public Health
Necrosis - etiology
Neurosurgery
Postoperative Complications
Prognosis
Radiography
Scoliosis - diagnostic imaging
Scoliosis - surgery
Spinal Fusion - adverse effects
Spinal Fusion - methods
Stomach - blood supply
Stomach - diagnostic imaging
Stomach - pathology
Surgical Orthopedics
Tomography, X-Ray Computed
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Summary:Introduction Corrections of spinal deformities have been associated with a potential of postoperative vessel-originating complications. Reports of occlusions of celiac artery seem though to be very rare. Case reports We present two cases that developed acute arterial supply impairment and subsequent liver and gastric necrosis due to an occlusion of celiac artery, after a spine deformity correction. In both patients a lateral surgical approach to the superior lumbar spine, lateral placement of cages and then a subsequent posterior fixation were performed. Review The literature search reveals the report of three similar cases, with potentially different pathogenetic mechanisms and with a different prognosis. This complication is assumed to occur due to a Medial Arcuate Ligament syndrome (MALS) developed postoperatively that leaded to compression of the celiac artery against the Medial Arcuate Ligament. The pathogenesis though remains unclear and two theories are assumed to explain the acute appearance of the syndrome; the alteration of the anatomic relationship between the vessels and the surrounding tissues due to the spine deformity correction and an intraoperative direct or indirect traction injury of the celiac trunk that caused or increased its pressure against the medial arcuate ligament. Conclusion The spine surgeon should be aware of the possibility of postoperative ischemia of the liver and stomach by occlusion of the celiac artery or its supplying branches. Specifically when a large correction of a kyphotic/kyphoscoliotic spine is planed, the surgeon should be alert for an appearance of a MALS.
ISSN:0940-6719
1432-0932
DOI:10.1007/s00586-016-4562-9