Purpose: To prospectively investigate the feasibility of contrast material-enhanced magnetic resonance (MR) angiography for visualization of the spinal vasculature in patients referred for video-assisted thoracoscopic surgical treatment of a thoracic herniated disk and to prospectively assess the influence of preoperative imaging of the spinal vasculature on the choice of surgical approach.
Materials and methods: Eight patients (three men and five women; mean age, 58 years; range, 42-83 years) with a thoracic herniated disk underwent contrast-enhanced MR angiography of the thoracoabdominal aorta and posterior branches. Imaging was performed with three-dimensional first-pass contrast-enhanced MR angiographic technique and a triple dose of gadolinium-based contrast agent. Images were analyzed by two observers in consensus to localize the Adamkiewicz artery (AKA) and its connections to the aorta and the anterior spinal artery (ASA). This information was used to determine any change in surgical approach.
Results: In all eight patients, the AKA, the ASA, and the connections with the aorta were identified. The AKA originated between T9 and L2 in all patients and derived from the left side of the aorta in 75% (six of eight) of the patients. In three patients in whom the AKA was observed on the left side, the surgical approach was changed to the right side to preserve spinal cord integrity.
Conclusion: Preoperative imaging of the AKA is feasible with contrast-enhanced MR angiography. Contrast-enhanced MR angiography can be used to image the main feeding arteries of the spinal cord in patients undergoing thoracoscopic spinal surgery, and results can be used to change the side of surgical approach.