title: Lumbar artery branches coursing vertically over the intervertebral discs of the lower lumbar spine: an anatomic study.
abstract: Bleeding from the lumbar artery is a potential complication during the transpsoas approach to the lower lumbar intervertebral discs. In this anatomic study, the morphological relationships between the branches of the lumbar artery and the lower intervertebral disc were investigated to assess the risk of injury to the branches of the lumbar segmental arteries.
  
  
  
  We studied 88 sites (86 lumbar arteries) at the third and fourth lumbar vertebrae bilaterally in 22 formalin-fixed cadavers. The branches of the lumbar artery coursing along the lateral sides of the lower intervertebral disc [muscular branch, anastomotic branch, and branch supplying the spinal nerve and plexus (BSNP)] and the iliolumbar artery running upward over the L4-5 disc were identified. Branches crossing the intervertebral discs vertically were evaluated.
  
  
  
  Muscular branches with a lumen structure longer than 2 cm coursed vertically over the middle third of the intervertebral disc in 3 of 88 sites (3.4 %). Anastomotic branches ran downward in 13 of 88 (14.8 %), and iliolumbar arteries ran upward on the posterior third of the lateral sides of the disc in 2 of 88 (2.3 %). BSNPs ran downward through the posterior third of the disc at 18 of 88 sites (20.5 %). Overall, the arterial branches coursed vertically over the posterior third of the lateral sides of the intervertebral discs in approximately 30 % of subjects.
  
  
  
  Lumbar artery branches coursed vertically over the middle third and the posterior third of the lateral sides of the intervertebral discs in approximately 3 and 30 % of subjects, respectively.
authors: Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan. hnojiri@juntendo.ac.jp.
authors: Hidetoshi
authors: 0000-0002-2359-3393
authors: H
authors: Nojiri
authors: Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan.
authors: Kei
authors: K
authors: Miyagawa
authors: Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan.
authors: Sammy
authors: S
authors: Banno
authors: Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan.
authors: Ikko
authors: I
authors: Sakamoto
authors: Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan.
authors: Masato
authors: M
authors: Koike
authors: Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan.
authors: Mamiko
authors: M
authors: Sawa
authors: Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan.
authors: Yoshiyuki
authors: Y
authors: Iwase
authors: Department of Anatomy and Life Structure, Juntendo University, Tokyo, Japan.
authors: Hiroyuki
authors: H
authors: Kudo
authors: Department of Anatomy and Life Structure, Juntendo University, Tokyo, Japan.
authors: Tatsuo
authors: T
authors: Sakai
authors: Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan.
authors: Kazuo
authors: K
authors: Kaneko
mesh_terms: D000328:Adult; D001012:Aorta, Abdominal / Q000033:anatomy & histology; D001158:Arteries / Q000033:anatomy & histology* / Q000293:injuries; D002102:Cadaver; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000033:anatomy & histology / Q000098:blood supply* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000098:blood supply* / Q000601:surgery; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D012306:Risk; D057772:Vascular System Injuries / Q000209:etiology*
keywords: Anatomy; Branch; Lumbar artery; Transpsoas approach; Vascular injury