Naoki Notani1, Masashi Miyazaki2, Toyomi Yoshiiwa1, Toshinobu Ishihara1, Hiroshi Tsumura1. 1. Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan. 2. Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan. masashim@oita-u.ac.jp.
Abstract
PURPOSE: To describe the first case of a patient who developed acute celiac artery compression syndrome (ACACS) after extensive correction of sagittal balance on an adult spinal deformity. METHODS: A 77-year-old woman presented with low back pain and spinal kyphosis deformity. We performed a two-stage correction with extreme lateral interbody fusion (XLIF), and her lumbar lordosis improved from -47° to 53°. However, after surgery, she experienced frequent vomiting and diarrhea. Contrast-enhanced computed tomography showed marked narrowing of the abdominal aorta at the L1/2 level, and both the celiac artery and superior mesenteric artery were compressed. Therefore, emergency surgery was performed. After laparotomy, we found that the small bowel exhibited an unfavorable color and that peristalsis had stopped. The aorta was compressed from the anterior direction at the upper side of the renal arteries. The median arcuate ligament (MAL) and celiac plexus were responsible for the compression. After the compression was relieved, the small bowel color and peristaltic activity improved. RESULTS: Postoperatively, there was no recurrence of abdominal symptoms. The patient could walk with a walking frame from 3 weeks postoperatively. CONCLUSION: ACACS is a life-threatening complication, and therefore, it is very important that ACACS is diagnosed and treated early. Spinal deformity surgeons should be aware of the possible occurrence of this condition after extensive correction of sagittal balance on adult spinal deformity.
PURPOSE: To describe the first case of a patient who developed acute celiac artery compression syndrome (ACACS) after extensive correction of sagittal balance on an adult spinal deformity. METHODS: A 77-year-old woman presented with low back pain and spinal kyphosis deformity. We performed a two-stage correction with extreme lateral interbody fusion (XLIF), and her lumbar lordosis improved from -47° to 53°. However, after surgery, she experienced frequent vomiting and diarrhea. Contrast-enhanced computed tomography showed marked narrowing of the abdominal aorta at the L1/2 level, and both the celiac artery and superior mesenteric artery were compressed. Therefore, emergency surgery was performed. After laparotomy, we found that the small bowel exhibited an unfavorable color and that peristalsis had stopped. The aorta was compressed from the anterior direction at the upper side of the renal arteries. The median arcuate ligament (MAL) and celiac plexus were responsible for the compression. After the compression was relieved, the small bowel color and peristaltic activity improved. RESULTS: Postoperatively, there was no recurrence of abdominal symptoms. The patient could walk with a walking frame from 3 weeks postoperatively. CONCLUSION:ACACS is a life-threatening complication, and therefore, it is very important that ACACS is diagnosed and treated early. Spinal deformity surgeons should be aware of the possible occurrence of this condition after extensive correction of sagittal balance on adult spinal deformity.
Authors: Alan H Daniels; Darin Jurgensmeier; Jason McKee; Marvin W Harrison; Charles R d'Amato Journal: Spine (Phila Pa 1976) Date: 2009-02-15 Impact factor: 3.468