Paraplegia with lumbar artery compression by the diaphragmatic crus

Abstract

The authors report three cases of transient and recurrent paraplegia due to compression of the second right lumbar artery by the diaphragmatic crus. Circumstances of appearance are suggestive when paraplegia occurs in dorsolumbar hyperlordosis and low cardiac output is an associated hemodynamic risk factor. Selective medullary arteriography is indispensable for diagnosis and can demonstrate three signs: an anterior spinal dorsolumbar artery (artery of Adamkiewicz) that does not descend to the conus medullaris; posterior spinal arteries arising from the second lumbar arteries that vascularize the conus medullaris; existence of a tight stenosis on the second right lumbar artery that is aggravated during dynamic maneuvers. Section of the right diaphragmatic crus and release of the second right lumbar artery from the aorta to the fibrous arcade of the psoas permits definitive cure of symptoms.

Focal Compression of the Upper Left Thoracic Intersegmental Arteries as a Potential Cause of Spinal Cord Ischemia

“…This mechanism would be very similar to the situation encountered at the lumbar level, in which the passage of upper lumbar ISAs through the crus of the diaphragm 2 occasionally results in extrinsic compression, leading to spinal cord ischemia when the involved vessel provides a significant spinal artery contributor. 1,25 Although surgical treatment can be offered at the lumbar level, with the compression being relieved by section of the pillar of the diaphragm, there is at this time no straightforward method addressing the upper thoracic ISA stenoses described in the present report. Several patients presenting with progressive or recurrent myelopathies of unclear etiologies, and in whom a stenosis or occlusion was shown to involve an ISA providing a prominent anterior RMA, were placed on prophylactic antiplatelet therapy with aspirin and/or clopidogrel.…”

Bilateral duplicated crura of the thoracoabdominal diaphragm

“…Cases of transient and recurrent paraplegia due to compression of the second right lumbar artery by the diaphragmatic crus have been noted. 14 Radiological and/or histological examination has confirmed the presence of tumors/cysts around the diaphragm. These could be benign or malignant.…”

Das Kompressionssyndrom der Lumbalarterien – Kasuistik eines seltenen Krankheitsbilds

“…Es finden sich in der vorliegenden medizinischen Literatur neben der hier präsentierten Beschreibung lediglich die erwähnte, multizentrische Fallserie aus Frankreich. Diese beschreibt über einen Zeitraum von 20 Jahren 3 Patienten mit der passenden Pathologie, Klinik und Therapie [1]. Klinisch führend ist neben der zumeist langwierigen Krankheitsgeschichte mit Konsultationen von mehreren Fachdisziplinen und dem entsprechend hohen Leidensdruck das Stürzen bei Mobilisierung, welches z. T. zur protektiven Immobilisierung im Rollstuhl führt.…”