The impact of preoperative angiographic identifi cation of the artery of adamkiewicz on surgical decision making in patients undergoing thoracolumbar corpectomy

Study Design. Retrospective study. Objective. To investigate the impact of spinal angiography on selection of surgical side in patients undergoing thoracolumbar corpectomy. Summary of Background Data. The artery of Adamkiewicz provides the major blood supply to the thoracolumbar spinal cord. Its location makes it vulnerable to injury during surgical procedures. Preoperative diagnostic spinal angiography is often used to determine the level and lateralization of the artery. Methods. Data were gathered regarding level and laterality of the Adamkiewicz artery in 34 patients who underwent lateral extracavitary approaches to the thoracolumbar spine, preceded by diagnostic spinal angiography for localization of that artery. Two experienced spine surgeons were retrospectively polled regarding ideal side of approach for each case. This was compared with the actual side that was selected after angiographic localization. Results. The artery was successfully identifi ed in 71% of patients. The artery was most commonly located on the left side (83%) between T9 and L1 (83%). Diagnostic angiography seemed to have influenced surgical decision making in 54% of cases. In 21% of patients, there was no need to alter the side of approach. In the remaining 25%, the surgical plan was not altered on the basis of angiographic data, presumably due to anatomic limitations. No angiography- or surgery-related complications occurred in any of the patients. Conclusion. Preoperative spinal angiography seems to impact surgical decision making with regard to alteration of the side of approach in patients undergoing thoracolumbar corpectomy via lateral extracavitary approaches.