PREOPERATIVE SPINAL ANGIOGRAPHY FOR LATERAL EXTRACAVITARY APPROACH TOTHORACIC AND LUMBAR SPINE

PURPOSE: To establish the safety, efficacy, and value of preoperative angiography in the surgical management of thoracic and lumbar spine di sease, in which it is important to avoid injury to the artery of Adamk iewicz or other Vessels that supply the spinal cord. METHODS: Sixty-on e patients were evaluated primarily using digital subtraction angiogra phy, low-osmolar or nonionic contrast agents, selective catheterizatio n limited to the region of disease, and careful angiographic technique s. RESULTS: Two minor (small hematomas of the groin) and no major comp lications of angiography were encountered. Arterial supply to the spin al cord was identified in 22 patients. In 17 patients (77%), the arter ial supply was in the region of planned surgery. In each of these pati ents the surgical approach was altered, either by dictating the use of a posterior surgical approach (four patients) or by altering the side of the lateral extracavitary approach (13 patients). CONCLUSION: Spin al angiography is a safe preoperative examination for thoracic and lum bar spine surgery. It is specifically useful when the lateral extracav itary surgical approach to spinal cord decompression and fusion (which predictably interrupts the terminal end-arterial blood supply to the spinal cord, if present) is planned.