The fifth lumbar artery arises from the posterior aorta at the L5 level or from the iliolumbar artery, supplying the L5 vertebral body, L5-S1 disc, and posterior lumbar muscles at this level. It is the most inferior of the paired lumbar segmental arteries.
The fifth lumbar artery is at risk during anterior L5-S1 approaches when the bifurcation vessels are mobilised. In anterior lumbar interbody fusion (ALIF) at L5-S1, the median sacral vessels are ligated and the fifth lumbar artery may require control depending on anatomy. Its disruption contributes to L5 vertebral body AVN in rare cases of segmental ischaemia after spinal surgery.
Identification and control of the fifth lumbar artery during L5-S1 ALIF preventing segmental haemorrhage and protecting the L5 vertebral body perfusion during anterior disc space preparation.
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