Nadja A Farshad-Amacker1,2, Mazda Farshad3, Julien Galley4, Reto Sutter4, Tobias Götschi5, Thomas Pfammatter6, Gilbert Puippe6, Urs J Muehlematter6. 1. Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. nadja.farshad@balgrist.ch. 2. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Forchstrasse 340, 8008, Zurich, Switzerland. nadja.farshad@balgrist.ch. 3. Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. 4. Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. 5. Unit for Clinical and Applied Research, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. 6. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
Abstract
PURPOSE: Abdominal aortic aneurysms (AAAs) affect the vascular perfusion of the lumbar spine. The treatment of AAAs with endovascular aortic aneurysm repair (EVAR) completely occludes the direct vascular supply to the lumbar spine. We hypothesized that patients with AAA who undergo EVAR show a different pattern of spinal degeneration than individuals without AAA. METHODS: In this retrospective institutional review board-approved study, 100 randomly selected patients with AAA who underwent EVAR with computed tomography (CT) scans between 2005 and 2017 were compared with age- and gender-matched controls without AAA. In addition, long-term follow-up CT images (> 6 months before EVAR, at the time of EVAR, and > 12 months after EVAR) of the patients were analysed to compare the progression of degeneration from before to after EVAR. Degeneration scores, lumbar levels with the most severe degeneration, and lumbar levels with progressive degeneration were analysed in all CT images. Fisher's exact test, Wilcoxon signed-rank test, and Mann-Whitney U test were performed for statistical analyses. RESULTS: Compared with the control group (n = 94), the most severe degeneration was more commonly detected in the mid-lumbar area in the patient group (n = 100, p = 0.016), with significantly more endplate erosions being detected in the lumbar spine (p = 0.015). However, EVAR did not result in significant additional acceleration of the degenerative process in the long-term follow-up analysis (n = 51). CONCLUSION: AAA is associated with atypical, more cranially located spinal degradation, particularly in the mid-lumbar segments; however, EVAR does not seem to additionally accelerate the degenerative process. This observation underlines the importance of disc and endplate vascularization in the pathomechanism of spinal degeneration. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
PURPOSE: Abdominal aortic aneurysms (AAAs) affect the vascular perfusion of the lumbar spine. The treatment of AAAs with endovascular aortic aneurysm repair (EVAR) completely occludes the direct vascular supply to the lumbar spine. We hypothesized that patients with AAA who undergo EVAR show a different pattern of spinal degeneration than individuals without AAA. METHODS: In this retrospective institutional review board-approved study, 100 randomly selected patients with AAA who underwent EVAR with computed tomography (CT) scans between 2005 and 2017 were compared with age- and gender-matched controls without AAA. In addition, long-term follow-up CT images (> 6 months before EVAR, at the time of EVAR, and > 12 months after EVAR) of the patients were analysed to compare the progression of degeneration from before to after EVAR. Degeneration scores, lumbar levels with the most severe degeneration, and lumbar levels with progressive degeneration were analysed in all CT images. Fisher's exact test, Wilcoxon signed-rank test, and Mann-Whitney U test were performed for statistical analyses. RESULTS: Compared with the control group (n = 94), the most severe degeneration was more commonly detected in the mid-lumbar area in the patient group (n = 100, p = 0.016), with significantly more endplate erosions being detected in the lumbar spine (p = 0.015). However, EVAR did not result in significant additional acceleration of the degenerative process in the long-term follow-up analysis (n = 51). CONCLUSION: AAA is associated with atypical, more cranially located spinal degradation, particularly in the mid-lumbar segments; however, EVAR does not seem to additionally accelerate the degenerative process. This observation underlines the importance of disc and endplate vascularization in the pathomechanism of spinal degeneration. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
Authors: T Videman; S Sarna; M C Battié; S Koskinen; K Gill; H Paananen; L Gibbons Journal: Spine (Phila Pa 1976) Date: 1995-03-15 Impact factor: 3.468
Authors: Michele C Battié; Tapio Videman; Esko Levälahti; Kevin Gill; Jaakko Kaprio Journal: Spine (Phila Pa 1976) Date: 2008-12-01 Impact factor: 3.468