Using MRI to Evaluate Anatomic Significance of Aortic Bifurcation, Right Renal Artery, and Conus Medullaris When Locating Lumbar Vertebral Segments

Lee, Changhee; Seo, Bo Kyoung; Choi, Yong; Shin, Hyun Joon; Park, Jeong Hee; Jeon, Hae Jeong; Kim, Kyeong Ah; Park, Cheol‐Min; Kim, Baek Hyun

doi:10.2214/ajr.182.5.1821295

Cited by 64 publications

(69 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…36 The use of anatomic markers, including the aortic bifurcation, right renal artery, and conus medullaris has been reported to be least reliable. Although Lee et al 37 report the position of the aortic bifurcation and right renal artery to be reliable landmarks for determining the lumbar vertebral segments on MR imaging and CT, these anatomic markers are widely believed to be less than satisfactory. 33 Although the right renal artery is usually located at the L1-2 disk space, 25% of the time it is either not imaged or is present at another location.…”

Section: Numbering Techniquementioning

confidence: 99%

See 1 more Smart Citation

Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance

Konin

Walz²

2010

AJNR Am J Neuroradiol

298

262

View full text Add to dashboard Cite

SUMMARY:LSTVs are common within the spine, and their association with low back pain has been debated in the literature for nearly a century. LSTVs include sacralization of the lowest lumbar vertebral body and lumbarization of the uppermost sacral segment. These vertebral bodies demonstrate varying morphology, ranging from broadened transverse processes to complete fusion. Low back pain associated with an LSTV may arise from the level above the transition, the contralateral facet when unilateral, and/or the anomalous articulation when present. Although this association is still somewhat controversial, beyond dispute is the importance of identifying an LSTV in patients in whom a surgical or interventional procedure is planned. This is essential to avoid an intervention or surgery at an incorrect level. In this article, each of these issues will be addressed with attention to identifying and correctly numbering LSTVs as well as detecting imaging findings related to the genesis of low back pain.ABBREVIATIONS: AP ϭ anteroposterior; LSTV ϭ lumbosacral transitional vertebra L STVs are congenital spinal anomalies defined as either sacralization of the lowest lumbar segment or lumbarization of the most superior sacral segment of the spine. LSTVs are common in the general population, with a reported prevalence of 4%-30%.1-15 The degree of morphologic variation of these segments ranges from L5 vertebrae with broadened elongated transverse processes to complete fusion to the sacrum. Conversely, the S1 vertebral segment can show varying degrees of lumbarization, such as the formation of an anomalous articulation rather than fusion to the remainder of the sacrum, well-formed lumbar-type facet joints, a more squared appearance in the sagittal plane, as well as a well-formed fully-sized disk, rather than the smallersized disk typically seen between S1 and S2.

show abstract

Section: Numbering Techniquementioning

confidence: 99%

“…33 Variability may be seen in the position of the aortic bifurcation as it has been found at L4 in 83% of patients. 37 Lee et al have also shown that the conus medullaris should not be used as a landmark because its position is quite variable.…”

Section: Numbering Techniquementioning

confidence: 99%

Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance

Konin

Walz²

2010

AJNR Am J Neuroradiol

298

262

View full text Add to dashboard Cite

show abstract

“…The level of the consus medullaris is variable, ranging between middle third T12 to upper third L3 vertebrae. About 30% of patient population has a mean conus position at the lower third L1 vertebrae [15]. The lumbar spine MRI was reviewed in this case, the conus medullaris ended at the superior end plate of L1 verterbra.…”

Section: Discussionmentioning

confidence: 93%

Subdural Hematoma and Postdural Puncture Headache from Intrathecal Pump Placement Resolved with Lumbar Epidural Blood Patch

Ng¹,

Romo²,

Wang³

2014

OJAnes

View full text Add to dashboard Cite

Intrathecal drug delivery systems are commonly used in the management of chronic pain, cancer pain and neuromuscular disorders with muscle spasticity. The complications associated with intrathecal pump placement include persistent cerebrospinal fluid (CSF) leak, hygroma, meningitis, and granuloma formation. A severe persistent CSF leak may cause postdural puncture headache along with acute intracranial subdural hematoma, which can be potentially life threatening. Surgical exploration with dural repair is required to treat this severe complication when conservative treatments fail. We present a case report of severe persistent CSF leak after intrathecal pump revision that resulted in a subdural hematoma and postdural puncture headache. In this case, an epidural blood patch was performed using epidural catheter under fluoroscopic guidance to target the site of CSF leak and to avoid damaging the intrathecal catheter. This patient's headache was resolved and intrathecal catheter remained intact after this blood patch.

show abstract

“…They found that aortic bifurcation at the level of L4 vertebra in 131 cases (70.1%), at the 4 th lumbar intervertebral disc in 23 cases (12.3%) and at the level of L5 vertebra in 33 cases (17.6%) [5]. Lee CH et al, studied 210 patients by MRI and found that aortic bifurcation level was at L4 vertebra (83%) [6]. In present study, the aortic bifurcation level was at L4 vertebra in 16 cases (64%) and at the level of L4-L5 intervertebral disc in 4 cases (16%).…”

Section: Resultsmentioning

confidence: 99%

Study of Aortic-Common Iliac Bifurcation and Its Clinical Significance

Deswal

Tamang

Bala

2014

JCDR

View full text Add to dashboard Cite

Objective: To determine the position of the aortic bifurcation, angle of aortic-common iliac bifurcation in relation to the lumbar vertebra, diameter of distal aorta, length of common iliac, diameter of iliac at bifurcation in cadavers. Materials and Methods:The present study was done on 25 cadavers (16 males, 9 females) used for the dissection by 1 st year MBBS students. The dissections were performed by anterior approach to the lumbar vertebra. The position of the aortic bifurcation, aortic bifurcation angle were measured in relation to lumbar vertebra. The remaining parameters were measured with the help of digital vernier caliper. Results:The aortic bifurcation was seen in between L3 and L5 vertebra in all the cases. In majority of cases, 16 (64%), the bifurcation was observed at the level of L4 vertebra. During statistical analysis, significant differences were observed in the mean values of aortic-iliac take off angles and in mean diameter of distal aorta. Conclusion:The exact location of aortic bifurcation is useful when invasive procedures are performed in the pelvis, laproscopic lumbar discectomy and lumbosacral total disc arthroplasty.The aortic bifurcation mostly found at the level of L4 vertebra in the present study similar to previous studies. The aortic bifurcation can be a reliable landmark for determining the lumbar vertebral segments on MRI or CT.

show abstract

Using MRI to Evaluate Anatomic Significance of Aortic Bifurcation, Right Renal Artery, and Conus Medullaris When Locating Lumbar Vertebral Segments

Abstract: The aortic bifurcation, the right renal artery, and the combination of these structures can be reliable landmarks for determining the lumbar vertebral segments on MRI or CT. However, conus medullaris cannot be considered a good landmark because of its variable locations.

Cited by 64 publications

References 19 publications

Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance

Lumbosacral Transitional Vertebrae: Classification, Imaging Findings, and Clinical Relevance

Subdural Hematoma and Postdural Puncture Headache from Intrathecal Pump Placement Resolved with Lumbar Epidural Blood Patch

Study of Aortic-Common Iliac Bifurcation and Its Clinical Significance

Contact Info

Product

Resources

About