title: Temporary liver and stomach necrosis after lateral approach for interbody fusion and deformity correction of lumbar spine: report of two cases and review of the literature.
abstract: Corrections of spinal deformities have been associated with a potential of postoperative vessel-originating complications. Reports of occlusions of celiac artery seem though to be very rare.
  
  
  
  We present two cases that developed acute arterial supply impairment and subsequent liver and gastric necrosis due to an occlusion of celiac artery, after a spine deformity correction. In both patients a lateral surgical approach to the superior lumbar spine, lateral placement of cages and then a subsequent posterior fixation were performed.
  
  
  
  The literature search reveals the report of three similar cases, with potentially different pathogenetic mechanisms and with a different prognosis. This complication is assumed to occur due to a Medial Arcuate Ligament syndrome (MALS) developed postoperatively that leaded to compression of the celiac artery against the Medial Arcuate Ligament. The pathogenesis though remains unclear and two theories are assumed to explain the acute appearance of the syndrome; the alteration of the anatomic relationship between the vessels and the surrounding tissues due to the spine deformity correction and an intraoperative direct or indirect traction injury of the celiac trunk that caused or increased its pressure against the medial arcuate ligament.
  
  
  
  The spine surgeon should be aware of the possibility of postoperative ischemia of the liver and stomach by occlusion of the celiac artery or its supplying branches. Specifically when a large correction of a kyphotic/kyphoscoliotic spine is planed, the surgeon should be alert for an appearance of a MALS.
authors.affiliation: Spine Service, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland. charilaosvasileiadis@sonnenhof.ch.
authors.forename: Haris S
authors.initials: HS
authors.lastname: Vasiliadis
authors.affiliation: Spine Service, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland.
authors.forename: Regula
authors.initials: R
authors.lastname: Teuscher
authors.affiliation: Spine Service, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland.
authors.forename: Mark
authors.initials: M
authors.lastname: Kleinschmidt
authors.affiliation: Radiology Department, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland.
authors.forename: Susanne
authors.initials: S
authors.lastname: Marrè
authors.affiliation: Spine Service, Sonnenhof Hospital, Buchserstrasse 30, 3006, Bern, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Heini
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D002445:Celiac Artery / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D009336:Necrosis / Q000209:etiology; D011183:Postoperative Complications; D011379:Prognosis; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013270:Stomach / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed
keywords: Celiac artery; Complication; Liver necrosis; Lumbar spine; Spine deformity